Provider Demographics
NPI:1710074810
Name:CARSON, SUSAN M (LISW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:CARSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9301
Mailing Address - Country:US
Mailing Address - Phone:614-781-1340
Mailing Address - Fax:614-841-1567
Practice Address - Street 1:97 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9301
Practice Address - Country:US
Practice Address - Phone:614-781-1340
Practice Address - Fax:614-841-1567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00056551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical