Provider Demographics
NPI:1811032386
Name:AUSTIN, SUSAN REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:REBECCA
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:AUSTIN
Other - Last Name:CACIOPPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2345 HAWKINS LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1385
Mailing Address - Country:US
Mailing Address - Phone:541-554-2858
Mailing Address - Fax:
Practice Address - Street 1:1255 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3570
Practice Address - Country:US
Practice Address - Phone:541-687-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL28631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical