Provider Demographics
NPI:1669566261
Name:ECKBERG, SUSAN G (MSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:ECKBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 19079
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22320
Mailing Address - Country:US
Mailing Address - Phone:703-518-8388
Mailing Address - Fax:
Practice Address - Street 1:238 BROOKLEY AVENUE
Practice Address - Street 2:BLDG 1300, STE 259
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032-0101
Practice Address - Country:US
Practice Address - Phone:202-404-6502
Practice Address - Fax:202-404-2911
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW9401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical