Provider Demographics
NPI:1134663693
Name:FERTIG, SUSAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FERTIG
Suffix:
Gender:
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 1:10328 LIMESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-6951
Mailing Address - Country:US
Mailing Address - Phone:301-461-9686
Mailing Address - Fax:
Practice Address - Street 1:10328 LIMESTONE AVE
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-6951
Practice Address - Country:US
Practice Address - Phone:301-461-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20061104100000X, 1041C0700X
VA09040136181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty