Provider Demographics
NPI:1881600765
Name:THOMPSON, SUSAN C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:THOMPSON
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 1:216 W 9TH AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1242
Mailing Address - Country:US
Mailing Address - Phone:724-882-7097
Mailing Address - Fax:724-671-7292
Practice Address - Street 1:216 W 9TH AVE STE 22
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1242
Practice Address - Country:US
Practice Address - Phone:724-882-7097
Practice Address - Fax:724-671-7292
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0136881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA009717QFSMedicare ID - Type Unspecified