Provider Demographics
NPI:1932170594
Name:CORLEY, SUSAN (LCSWC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 FREDERICK CROSSING LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5176
Mailing Address - Country:US
Mailing Address - Phone:240-415-8893
Mailing Address - Fax:240-466-1993
Practice Address - Street 1:5970 FREDERICK CROSSING LN STE 100
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5176
Practice Address - Country:US
Practice Address - Phone:240-415-8893
Practice Address - Fax:240-466-1993
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10908104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD698800800Medicaid
MD698800800Medicaid