1659343366 NPI number — MS. SUSAN P. MENTER LCSW MSW

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659343366 NPI number — MS. SUSAN P. MENTER LCSW MSW

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MENTER

Provider First Name:

SUSAN

Provider Middle Name:

P.

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

LCSW MSW

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

PHELPS

Provider Other First Name:

SUSAN

Provider Other Middle Name:

JANE

Provider Other Name Prefix Text:

MISS

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

1

NPI Number:

1659343366

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/02/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

512 S LYNNHAVEN RD STE 101

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

VIRGINIA BEACH

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23452-6664

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

757-306-4232

Provider Business Mailing Address Fax Number:

757-303-4235

Provider First Line Business Practice Location Address:

512 S LYNNHAVEN RD STE 101

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

VIRGINIA BEACH

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23452-6664

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

757-306-4232

Provider Business Practice Location Address Fax Number:

757-303-4235

Provider Enumeration Date:

02/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  0904000587 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 120567 . This is a "COM PSYCH" identifier . This identifiers is of the category "OTHER".
• Identifier: 10668 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 310889 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 132039 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
• Identifier: 39723356 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: P00129353 . This is a "MCARE RAILROAD" identifier . This identifiers is of the category "OTHER".
• Identifier: C02527 . This is a "MCARE GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 008900922 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 081808 . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 000741 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
• Identifier: 049399 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 061013 . This is a "ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 061013 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 061013 . This is a "ANTHEM HEALTH KEEPERS" identifier . This identifiers is of the category "OTHER".