Provider Demographics
NPI:1942694682
Name:SUSANNA O. MCNAMARA,LCSW-C, LLC
Entity Type:Organization
Organization Name:SUSANNA O. MCNAMARA,LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:OKSANA
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-373-8765
Mailing Address - Street 1:42180 CIDER LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-2387
Mailing Address - Country:US
Mailing Address - Phone:301-373-8765
Mailing Address - Fax:
Practice Address - Street 1:21945 THREE NOTCH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1562
Practice Address - Country:US
Practice Address - Phone:301-997-1494
Practice Address - Fax:410-586-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1041C0700XOtherPRIMARY TAXONOMY
MD941L70Medicaid