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NPI Code Detail

MEDICARE: SUZANNE CONLON TRAUB LCMHCA

MEDICARE: SUZANNE CONLON TRAUB LCMHCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorA19235NC

General Provider Information

NPI Number : 1023352986
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZANNE CONLON TRAUB LCMHCA
Provider Business Mailing Address
First Line : PO BOX 759194
Second Line :
City : BALTIMORE
State : MD
Zip : 21275-9194
Country : US
Telephone Number : 540-710-6085
Fax Number : 540-710-6447
Provider Business Practice Location Address
First Line : 360 N CASWELL RD STE 204
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2442
Country : US
Telephone Number : 704-998-9346
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2012
Last Update Date : 10/25/2024

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