Healthcare Provider Details

I. General information

NPI: 1104332923
Provider Name (Legal Business Name): SUSAN TROTMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7892 GEORGE MASON DR
GLOUCESTER VA
23061-4587
US

IV. Provider business mailing address

7892 GEORGE MASON DR
GLOUCESTER VA
23061-4587
US

V. Phone/Fax

Practice location:
  • Phone: 757-510-0201
  • Fax:
Mailing address:
  • Phone: 757-510-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3932
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: