1194865105 NPI number — MS. SUSAN ELIZABETH MCCUE LCSW

Table of content: MS. SUSAN ELIZABETH MCCUE LCSW (NPI 1194865105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194865105 NPI number — MS. SUSAN ELIZABETH MCCUE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCUE
Provider First Name:
SUSAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROHMER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
MCCUE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194865105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95927-1255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-342-0070
Provider Business Mailing Address Fax Number:
530-342-0070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 GOVERNORS LN STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-5590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-342-0070
Provider Business Practice Location Address Fax Number:
530-342-0070
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 25910 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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