Provider Demographics
NPI:1912327131
Name:WILBERGER, SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:WILBERGER
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 1:416 E MAIN ST
Mailing Address - Street 2:#301F
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5295
Mailing Address - Country:US
Mailing Address - Phone:434-250-9424
Mailing Address - Fax:434-985-5899
Practice Address - Street 1:416 E MAIN ST
Practice Address - Street 2:#301F
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5295
Practice Address - Country:US
Practice Address - Phone:434-250-9424
Practice Address - Fax:434-985-5899
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040085661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical