Provider Demographics
NPI:1659343366
Name:MENTER, SUSAN P (LCSW MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:P
Last Name:MENTER
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:JANE
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:512 S LYNNHAVEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6664
Mailing Address - Country:US
Mailing Address - Phone:757-306-4232
Mailing Address - Fax:757-303-4235
Practice Address - Street 1:512 S LYNNHAVEN RD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6664
Practice Address - Country:US
Practice Address - Phone:757-306-4232
Practice Address - Fax:757-303-4235
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
120567OtherCOM PSYCH
10668OtherCIGNA
310889OtherMAMSI
132039OtherMANAGED HEALTH NETWORK
39723356OtherMULTIPLAN
P00129353OtherMCARE RAILROAD
C02527OtherMCARE GROUP
VA008900922Medicaid
081808OtherSENTARA OPTIMA
000741OtherVALUE OPTIONS
049399OtherMAGELLAN
061013OtherANTHEM PPO
061013OtherBCBS
061013OtherANTHEM HEALTH KEEPERS
C02527OtherMCARE GROUP
VA800001422Medicare PIN