Provider Demographics
NPI:1659776037
Name:MCNAMARA, SUSAN (LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:SCOUT
Other - Middle Name:
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6417 N 52ND PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4158
Mailing Address - Country:US
Mailing Address - Phone:602-692-7649
Mailing Address - Fax:
Practice Address - Street 1:6417 N 52ND PL
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-4158
Practice Address - Country:US
Practice Address - Phone:602-692-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10835101YA0400X
AZLPC10338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)