Provider Demographics
NPI:1780739615
Name:CHACE, SUSAN L (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:CHACE
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 1:8005 RODGERS RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1325
Mailing Address - Country:US
Mailing Address - Phone:215-782-8088
Mailing Address - Fax:
Practice Address - Street 1:10125 VERREE RD SUITE 304
Practice Address - Street 2:JEWISH FAMILY AND CHILDRENS SERVICE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-673-0100
Practice Address - Fax:215-934-6284
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014129104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000008810009Medicaid
PA1000008810009Medicaid