Provider Demographics
NPI:1598003519
Name:FEDORKO, SUSAN MICHELLE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:FEDORKO
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 1:11937 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-2371
Mailing Address - Country:US
Mailing Address - Phone:301-992-0825
Mailing Address - Fax:
Practice Address - Street 1:11937 AZALEA DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-2371
Practice Address - Country:US
Practice Address - Phone:301-992-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical