Provider Demographics
NPI:1558468355
Name:VRTIS-YOUNGER, SUSAN MARIE (LCSW, ACSW, CART)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:VRTIS-YOUNGER
Suffix:
Gender:F
Credentials:LCSW, ACSW, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 SANTIAGO CT
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5783
Mailing Address - Country:US
Mailing Address - Phone:360-556-8214
Mailing Address - Fax:
Practice Address - Street 1:RAYMOND W BLISS ARMY HEALTH CENTER
Practice Address - Street 2:2240 E. WINROW AVENUE
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:360-556-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535771041C0700X
IN34005015A1041C0700X
NCC0059031041C0700X
ORL138811041C0700X
AZLCSW-178441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107920Medicaid