Provider Demographics
NPI:1912057282
Name:BYERLY, SUSAN KAY (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:BYERLY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BOUDEN
Other - Last Name:BYERLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0340
Mailing Address - Country:US
Mailing Address - Phone:919-776-6911
Mailing Address - Fax:919-776-6957
Practice Address - Street 1:226 E TRADE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332
Practice Address - Country:US
Practice Address - Phone:919-776-6911
Practice Address - Fax:919-776-6957
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003379103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2873461Medicare ID - Type Unspecified