Provider Demographics
NPI:1881013605
Name:CLIBURN ARNOLD, SUSAN ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALEXANDRA
Last Name:CLIBURN ARNOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1420
Mailing Address - Country:US
Mailing Address - Phone:304-654-9390
Mailing Address - Fax:
Practice Address - Street 1:410 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1420
Practice Address - Country:US
Practice Address - Phone:304-654-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6013104100000X
KY2529421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid