Provider Demographics
NPI:1477091064
Name:SUSSER, MELISSA ARON (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ARON
Last Name:SUSSER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ARON
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:8800 HARNESS TRL
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2555
Mailing Address - Country:US
Mailing Address - Phone:224-628-3108
Mailing Address - Fax:
Practice Address - Street 1:4125 ALBEMARLE ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2105
Practice Address - Country:US
Practice Address - Phone:224-628-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1041C0700X
DC500810971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical