Provider Demographics
NPI:1649990920
Name:NIMMANHEMINDA, SUSAN UMBERGER (PHD, LCSW, CAS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:UMBERGER
Last Name:NIMMANHEMINDA
Suffix:
Gender:F
Credentials:PHD, LCSW, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 CANYON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5655
Mailing Address - Country:US
Mailing Address - Phone:720-909-6413
Mailing Address - Fax:
Practice Address - Street 1:2305 CANYON BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5655
Practice Address - Country:US
Practice Address - Phone:720-909-6413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO009893051041C0700X
CO0009893051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical