Provider Demographics
NPI:1962463588
Name:STEIN, SUSAN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:STEIN
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 1:501 JOE STEIN RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3327
Mailing Address - Country:US
Mailing Address - Phone:985-809-8036
Mailing Address - Fax:985-809-7375
Practice Address - Street 1:5001 HWY. 190, SUITE D-4
Practice Address - Street 2:FAIRWAY CENTRE OFFICE PARK
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-809-8036
Practice Address - Fax:985-809-7375
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical