Provider Demographics
NPI:1023451556
Name:KERPETENOGLU, SUZAN EILEEN (LCSW-C)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:EILEEN
Last Name:KERPETENOGLU
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 STANFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-628-6120
Mailing Address - Fax:410-628-9825
Practice Address - Street 1:10400 RIDGLAND RD
Practice Address - Street 2:STE 1
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2715
Practice Address - Country:US
Practice Address - Phone:410-628-6120
Practice Address - Fax:410-628-9825
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD078751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical