Provider Demographics
NPI:1821234220
Name:SPAN, SUSAN RACHEL (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RACHEL
Last Name:SPAN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3157
Mailing Address - Country:US
Mailing Address - Phone:215-646-1075
Mailing Address - Fax:215-827-5219
Practice Address - Street 1:471 S SWEET GUM LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2601
Practice Address - Country:US
Practice Address - Phone:267-252-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW011375L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical