Healthcare Provider Details

I. General information

NPI: 1295860880
Provider Name (Legal Business Name): SUSAN E. NEANDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CRESCENT WAY SUITE 3
ARCATA CA
95521-6780
US

IV. Provider business mailing address

1335 VIRGINIA WAY
ARCATA CA
95521-6853
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-3998
  • Fax: 707-822-3998
Mailing address:
  • Phone: 707-822-3998
  • Fax: 707-822-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: