Provider Demographics
NPI:1447374558
Name:PATRICK, SUSAN KINNEY (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KINNEY
Last Name:PATRICK
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 1:3412 GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2910
Mailing Address - Country:US
Mailing Address - Phone:713-521-3537
Mailing Address - Fax:713-662-3646
Practice Address - Street 1:3513 AUDUBON PL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-4413
Practice Address - Country:US
Practice Address - Phone:173-521-3537
Practice Address - Fax:713-662-3646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23659OtherCIGNA
TX5609205OtherAETNA
TX00S18YMedicare ID - Type Unspecified
TX5609205OtherAETNA