Provider Demographics
NPI:1558413740
Name:DROBIS, SUSAN MORGANROTH (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MORGANROTH
Last Name:DROBIS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JANE
Other - Last Name:MOGANROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4943 BRANDY WINE ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4330
Mailing Address - Country:US
Mailing Address - Phone:202-244-0912
Mailing Address - Fax:
Practice Address - Street 1:4545 42ND ST NW
Practice Address - Street 2:STE 304
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4623
Practice Address - Country:US
Practice Address - Phone:202-686-9005
Practice Address - Fax:202-363-1434
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3002531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R24220Medicare UPIN
637733Medicare ID - Type Unspecified