Provider Demographics
NPI:1912326588
Name:WEISBERG, SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WEISBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 CALIFORNIA AVE SW
Mailing Address - Street 2:246
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2405
Mailing Address - Country:US
Mailing Address - Phone:206-372-5851
Mailing Address - Fax:
Practice Address - Street 1:2701 CALIFORNIA AVE SW
Practice Address - Street 2:246
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2405
Practice Address - Country:US
Practice Address - Phone:206-372-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602967531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical