Provider Demographics
NPI:1578668471
Name:WEINSTEIN, SUSAN W (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:W
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2448
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-2448
Mailing Address - Country:US
Mailing Address - Phone:360-692-2633
Mailing Address - Fax:360-779-5120
Practice Address - Street 1:9125 CENTRAL VALLEY RD NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311
Practice Address - Country:US
Practice Address - Phone:360-692-2633
Practice Address - Fax:360-779-5120
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004536104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8541195Medicaid
R54704Medicare UPIN
WAGAB25779Medicare PIN
WAG GAB25778Medicare PIN
WAG GAB25779Medicare PIN
WAG8872570Medicare PIN