Provider Demographics
NPI:1750853404
Name:MCCLARE, SUSAN (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCCLARE
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1803
Mailing Address - Country:US
Mailing Address - Phone:410-507-7158
Mailing Address - Fax:
Practice Address - Street 1:8338 VETERANS HWY STE 205B
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2637
Practice Address - Country:US
Practice Address - Phone:410-507-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist