Provider Demographics
NPI:1679595292
Name:PARKER, SUSAN KAY (MSW LISW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:PARKER
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MACKEY AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935
Mailing Address - Country:US
Mailing Address - Phone:740-635-7792
Mailing Address - Fax:740-635-7755
Practice Address - Street 1:500 MACKEY AVE
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935
Practice Address - Country:US
Practice Address - Phone:740-635-7792
Practice Address - Fax:740-635-7755
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0002925104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW29292Medicare ID - Type Unspecified