Provider Demographics
NPI:1679592422
Name:CHESELDINE, SUSAN T (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:CHESELDINE
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 1:10401 HOSPITAL DR
Mailing Address - Street 2:SUITEG-03
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3110
Mailing Address - Country:US
Mailing Address - Phone:301-856-6000
Mailing Address - Fax:301-856-8398
Practice Address - Street 1:10401 HOSPITAL DR
Practice Address - Street 2:SUITE G-03
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3110
Practice Address - Country:US
Practice Address - Phone:301-856-6000
Practice Address - Fax:301-856-8398
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD088171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD856426400Medicaid
MD08817OtherLICENSE #
MD856426400Medicaid