Provider Demographics
NPI:1689299117
Name:MCBRIDE, SUSAN (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HALL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1656
Mailing Address - Country:US
Mailing Address - Phone:715-732-7760
Mailing Address - Fax:
Practice Address - Street 1:2500 HALL AVE STE A
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1656
Practice Address - Country:US
Practice Address - Phone:715-732-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI735-228106H00000X
WI2052-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist