Provider Demographics
NPI:1447308622
Name:STAFFORD, SUZAN M (EDD)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:M
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 RENO RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2941
Mailing Address - Country:US
Mailing Address - Phone:202-362-6623
Mailing Address - Fax:202-686-3578
Practice Address - Street 1:4545 42ND ST NW
Practice Address - Street 2:SUITE 212
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4623
Practice Address - Country:US
Practice Address - Phone:202-237-7035
Practice Address - Fax:202-686-3578
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV483103T00000X
DC1803103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist