Healthcare Provider Details

I. General information

NPI: 1821208737
Provider Name (Legal Business Name): SUSAN S. CHICCA LCSW-C BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 BIRMINGHAM WAY
WOODSTOCK MD
21163-1403
US

IV. Provider business mailing address

7691 SWEET HOURS WAY
COLUMBIA MD
21046-2477
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-2908
  • Fax:
Mailing address:
  • Phone: 410-381-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: