Provider Demographics
NPI:1609988070
Name:SUSIN, MARK STEVEN (LISW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVEN
Last Name:SUSIN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 ALLING DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2929
Mailing Address - Country:US
Mailing Address - Phone:216-986-1175
Mailing Address - Fax:216-986-1016
Practice Address - Street 1:2305 E AURORA RD
Practice Address - Street 2:STE. 12-A
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-1940
Practice Address - Country:US
Practice Address - Phone:216-663-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-21641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical