Provider Demographics
NPI:1487041059
Name:RICHARDSON, SUSAN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DISTILLERY DRIVE, SUITE 200
Mailing Address - Street 2:CARROLL COUNTY HEALTH DEPARTMENT BPWR
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5219
Mailing Address - Country:US
Mailing Address - Phone:410-876-4800
Mailing Address - Fax:410-871-3219
Practice Address - Street 1:10 DISTILLERY DRIVE, SUITE 200
Practice Address - Street 2:CARROLL COUNTY HEALTH DEPARTMENT BPWR
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5219
Practice Address - Country:US
Practice Address - Phone:410-876-4800
Practice Address - Fax:410-871-3219
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical