Provider Demographics
NPI:1720208622
Name:BANCROFT, SUSAN DENISE (LPCC-S, LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:LPCC-S, LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1227
Mailing Address - Country:US
Mailing Address - Phone:330-797-0096
Mailing Address - Fax:330-797-9148
Practice Address - Street 1:527 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1227
Practice Address - Country:US
Practice Address - Phone:330-797-0096
Practice Address - Fax:330-797-9148
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981149101YA0400X
OHE 0002756101YP2500X
OHS 0014236104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker