Provider Demographics
NPI:1811909815
Name:STEVENS, SUSAN J (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10917 BREWER HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3456
Mailing Address - Country:US
Mailing Address - Phone:301-984-3720
Mailing Address - Fax:
Practice Address - Street 1:4308 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4402
Practice Address - Country:US
Practice Address - Phone:301-984-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD695161Medicare ID - Type Unspecified