Provider Demographics
NPI:1952869356
Name:KATZMIRE, SUSAN (LACMH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KATZMIRE
Suffix:
Gender:F
Credentials:LACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:CECILTON
Mailing Address - State:MD
Mailing Address - Zip Code:21913-0767
Mailing Address - Country:US
Mailing Address - Phone:302-272-0625
Mailing Address - Fax:
Practice Address - Street 1:282 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7311
Practice Address - Country:US
Practice Address - Phone:443-987-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health