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General NPI Number Information
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NPI Number | 1144774068
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Entity Type | Individual
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Provider Name | SUSAN HALLIWELL KNADE LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 121A N WEST ST
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City | EASTON
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State | MD
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Zip | 21601-2709
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Country | US
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Telephone | 410-310-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 4767 SAILORS RETREAT RD
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City | OXFORD
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State | MD
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Zip | 21654-1740
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Country | US
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Telephone | 410-310-6215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 25382
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License Number State | MD
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