Provider Demographics
NPI:1437297694
Name:GUSEMAN, DAVID SCOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:GUSEMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 RIDDLE AVE
Mailing Address - Street 2:UNIT B-201
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2179
Mailing Address - Country:US
Mailing Address - Phone:302-898-8722
Mailing Address - Fax:302-261-0241
Practice Address - Street 1:5618 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5004
Practice Address - Country:US
Practice Address - Phone:302-898-8722
Practice Address - Fax:302-261-0241
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ-100007521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000030205Medicaid
DE492081Medicare ID - Type Unspecified