Provider Demographics
NPI:1427387463
Name:DUNCAN, SUSAN E (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-0111
Mailing Address - Country:US
Mailing Address - Phone:505-404-5209
Mailing Address - Fax:505-867-7826
Practice Address - Street 1:148 SPARTAN ALY
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6298
Practice Address - Country:US
Practice Address - Phone:505-404-5209
Practice Address - Fax:505-867-7826
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2804121041S0200X
NMC-082141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool