MEDICARE: SUSAN RUTH NICHOLS HOBBS LCSW

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
1	1041C0700X	Clinical Social Worker	CW015819	PA

General Provider Information

NPI Number	:	1760757876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN RUTH NICHOLS HOBBS LCSW

Provider Business Mailing Address
First Line	:	25 ROTHERMEL DR
Second Line	:
City	:	YEAGERTOWN
State	:	PA
Zip	:	17099-9707
Country	:	US
Telephone Number	:	717-248-8197
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 ROTHERMEL DR
Second Line	:
City	:	YEAGERTOWN
State	:	PA
Zip	:	17099-9707
Country	:	US
Telephone Number	:	717-248-8197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/22/2012

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