Provider Demographics
NPI:1801885496
Name:PESKIND, SUSAN I (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:I
Last Name:PESKIND
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 1:8542 E SAN BERNARDO DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2442
Mailing Address - Country:US
Mailing Address - Phone:480-998-4302
Mailing Address - Fax:602-843-5484
Practice Address - Street 1:14021 N 51ST AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4838
Practice Address - Country:US
Practice Address - Phone:602-843-5484
Practice Address - Fax:602-843-5498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-00611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S30367Medicare UPIN
CSW 61/IMedicare ID - Type Unspecified