Provider Demographics
NPI:1699822882
Name:KULP, SUSAN M (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:KULP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SPRING ST
Mailing Address - Street 2:201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4012
Mailing Address - Country:US
Mailing Address - Phone:301-587-5575
Mailing Address - Fax:
Practice Address - Street 1:1015 SPRING ST
Practice Address - Street 2:201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4012
Practice Address - Country:US
Practice Address - Phone:301-587-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD041791041C0700X
DCLC3006961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
001007OtherVALUE OPTIONS
647063Medicare ID - Type Unspecified