Provider Demographics
NPI:1902078348
Name:FUTERAL, SUSAN TODD (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:TODD
Last Name:FUTERAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:TODD
Other - Last Name:MYROWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7511 SLADE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4537
Mailing Address - Country:US
Mailing Address - Phone:410-580-1136
Mailing Address - Fax:410-580-1138
Practice Address - Street 1:7511 SLADE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4537
Practice Address - Country:US
Practice Address - Phone:410-580-1136
Practice Address - Fax:410-580-1138
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04787101YA0400X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist