Provider Demographics
NPI:1780678508
Name:SHUSTER, SUSAN H (LCSW, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:H
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 OPITZ BLVD
Mailing Address - Street 2:SUITE # 214A
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3321
Mailing Address - Country:US
Mailing Address - Phone:703-494-6880
Mailing Address - Fax:703-492-0505
Practice Address - Street 1:2200 OPITZ BLVD
Practice Address - Street 2:SUITE # 214A
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3321
Practice Address - Country:US
Practice Address - Phone:703-494-6880
Practice Address - Fax:703-492-0505
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710000533101YA0400X
VA09040020971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA210658OtherBC/BS FEP
VA346665OtherMDIPA GROUP
VA89-0255-1Medicaid
VAR60481Medicare UPIN