Provider Demographics
NPI:1932228608
Name:MATSKO, SUZANNE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:MATSKO
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 1:3635 OLD COURT RD STE 305
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3907
Mailing Address - Country:US
Mailing Address - Phone:443-717-0130
Mailing Address - Fax:443-327-4753
Practice Address - Street 1:3635 OLD COURT RD STE 305
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3907
Practice Address - Country:US
Practice Address - Phone:443-717-0130
Practice Address - Fax:443-327-4753
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD105778200Medicaid
MDCX87-0001OtherCAREFIRST BLUE CROSS