Provider Demographics
NPI:1609825934
Name:REUSSER, SUSAN DIANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DIANE
Last Name:REUSSER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:REUSSER NEE TRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4201 MEDICAL DRIVE SUITE 280
Mailing Address - Street 2:STV HCS-HCHV BLUFFCREEK TOWERS
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-616-9915
Mailing Address - Fax:210-616-9710
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:VA-NIHCS
Practice Address - City:FT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-426-5431
Practice Address - Fax:260-460-1481
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003845A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical