Provider Demographics
NPI:1447340542
Name:MCCUNE, SUSAN KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11521 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2053
Mailing Address - Country:US
Mailing Address - Phone:724-864-1693
Mailing Address - Fax:724-864-7978
Practice Address - Street 1:11521 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2053
Practice Address - Country:US
Practice Address - Phone:724-864-1693
Practice Address - Fax:724-864-7978
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0132181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA904248OtherHIGHMARK BC/BS
PA904248Medicare ID - Type Unspecified