Provider Demographics
NPI:1740993740
Name:BORGHESE, SUSAN L (LSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BORGHESE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 RAVINES EDGE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5426
Mailing Address - Country:US
Mailing Address - Phone:614-985-3112
Mailing Address - Fax:614-410-8827
Practice Address - Street 1:8100 RAVINES EDGE CT STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5426
Practice Address - Country:US
Practice Address - Phone:614-985-3112
Practice Address - Fax:614-410-8827
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2410549101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator