1942694682 NPI number — SUSANNA O. MCNAMARA,LCSW-C, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942694682 NPI number — SUSANNA O. MCNAMARA,LCSW-C, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSANNA O. MCNAMARA,LCSW-C, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942694682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42180 CIDER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20636-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-373-8765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21945 THREE NOTCH RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LEXINGTON PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20653-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-997-1494
Provider Business Practice Location Address Fax Number:
410-586-3674
Provider Enumeration Date:
03/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MCNAMARA
Authorized Official First Name:
SUSANNA
Authorized Official Middle Name:
OKSANA
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
301-373-8765

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  11540 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1041C0700X . This is a "PRIMARY TAXONOMY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 941L70 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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