=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699045567
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN ALBERTA VANDERHOFF L.C.S.W.-C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2012
-----------------------------------------------------
Last Update Date | 01/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 288 E GREEN ST
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-5410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-751-5970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6409 BANBURY RD
-----------------------------------------------------
City | IDLEWYLDE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21239-1342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-925-0364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 09438
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------