Provider Demographics
NPI:1578503629
Name:BELANEY, SUSAN L (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BELANEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26366 ALGER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3503
Mailing Address - Country:US
Mailing Address - Phone:248-568-3643
Mailing Address - Fax:248-548-1206
Practice Address - Street 1:26366 ALGER ST
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3503
Practice Address - Country:US
Practice Address - Phone:248-568-3643
Practice Address - Fax:248-548-1206
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N67970Medicare PIN