Provider Demographics
NPI:1811043128
Name:GEOGHEGAN, SUSAN GREENWELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GREENWELL
Last Name:GEOGHEGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:GREENWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6003 TAYLOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1988
Mailing Address - Country:US
Mailing Address - Phone:513-777-9588
Mailing Address - Fax:
Practice Address - Street 1:28208 STATE ROAD 1
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:IN
Practice Address - Zip Code:47060-9686
Practice Address - Country:US
Practice Address - Phone:812-576-1600
Practice Address - Fax:812-576-1602
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4730103T00000X
KY0826103T00000X
IN20042311A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH183465000OtherMAGELLAN
OH000000003586OtherANTHEM
OHGECP15473Medicare ID - Type Unspecified