Provider Demographics
NPI:1447314562
Name:STUTMAN, SUZANNE (MSW, LCSW, BCD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:STUTMAN
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 JENIFER ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1806
Mailing Address - Country:US
Mailing Address - Phone:202-364-0402
Mailing Address - Fax:202-363-6849
Practice Address - Street 1:4601 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5700
Practice Address - Country:US
Practice Address - Phone:202-364-0402
Practice Address - Fax:202-363-6849
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC301337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491100Medicare UPIN