Provider Demographics
NPI:1902103401
Name:EGAN, SUSAN COLEMAN (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:COLEMAN
Last Name:EGAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 PEABODY ST NW
Mailing Address - Street 2:#1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2046
Mailing Address - Country:US
Mailing Address - Phone:202-246-8612
Mailing Address - Fax:
Practice Address - Street 1:10401 OLD GEORGETOWN RD
Practice Address - Street 2:#105
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1911
Practice Address - Country:US
Practice Address - Phone:202-246-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD058111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05811OtherSTATE OF MD. BOARD OF SOCIAL WORK EXAMINERS