Provider Demographics
NPI:1578587325
Name:MARTIN, SUSAN A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 OAKWOOD DR
Mailing Address - Street 2:OAKWOOD ESTATES
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-9500
Mailing Address - Country:US
Mailing Address - Phone:570-341-7301
Mailing Address - Fax:570-341-2221
Practice Address - Street 1:1818 WAYNE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2787
Practice Address - Country:US
Practice Address - Phone:570-343-8444
Practice Address - Fax:570-341-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000957L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical