MEDICARE: EVE SUSSMAN LICSW,LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker	LC200001403	DC
4	1041C0700X	Clinical Social Worker	0904014126	VA
5	1041C0700X	Clinical Social Worker	224344	MA
6	1041C0700X	Clinical Social Worker	123450	MA

General Provider Information

NPI Number	:	1306391388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVE SUSSMAN LICSW,LCSW

Provider Business Mailing Address
First Line	:	PO BOX 4950
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-0150
Country	:	US
Telephone Number	:	781-810-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 CHAIN BRIDGE RD STE 303
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-4501
Country	:	US
Telephone Number	:	781-810-8013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	02/05/2024

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