Provider Demographics
NPI:1710935358
Name:GETTY-EVANS, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GETTY-EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5143 A W WOODMILL DR
Mailing Address - Street 2:STE 24
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4067
Mailing Address - Country:US
Mailing Address - Phone:302-999-8426
Mailing Address - Fax:
Practice Address - Street 1:5143A W WOODMILL DR
Practice Address - Street 2:STE 24
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4067
Practice Address - Country:US
Practice Address - Phone:302-778-1288
Practice Address - Fax:302-778-1289
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100007081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000028567Medicaid
DE232905LCSOtherBLUE CROSS