Provider Demographics
NPI:1801948815
Name:SMALL, SUSAN ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:SMALL
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 1:2964 BELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2015
Mailing Address - Country:US
Mailing Address - Phone:412-441-3373
Mailing Address - Fax:412-441-3324
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:SUITE A107
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-441-3373
Practice Address - Fax:412-441-3324
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0139591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA644340Medicare ID - Type Unspecified