Provider Demographics
NPI:1841572278
Name:DIDONATO, SUSAN R (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:DIDONATO
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4142
Mailing Address - Country:US
Mailing Address - Phone:410-533-6813
Mailing Address - Fax:
Practice Address - Street 1:1027 COVINGTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4142
Practice Address - Country:US
Practice Address - Phone:410-533-6813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLPC5075101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor