Provider Demographics
NPI:1871658781
Name:BOOKFOR, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOOKFOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:BOOKFOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5016 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2221
Mailing Address - Country:US
Mailing Address - Phone:703-750-0258
Mailing Address - Fax:815-550-1718
Practice Address - Street 1:5016 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2221
Practice Address - Country:US
Practice Address - Phone:703-250-0258
Practice Address - Fax:815-550-1718
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0145691041C0700X
VA09040091031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02545Medicare UPIN
PA075220GNYMedicare ID - Type Unspecified