MEDICARE: MS. SUSAN D. LOFTIS LCSW-C

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	1041C0700X	Clinical Social Worker	05581	MD

General Provider Information

NPI Number	:	1316132277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN D. LOFTIS LCSW-C

Provider Business Mailing Address
First Line	:	44 TRIFECTA PL
Second Line	:	STE 205
City	:	CHARLES TOWN
State	:	WV
Zip	:	25414-5720
Country	:	US
Telephone Number	:	304-728-3716
Fax Number	:	304-728-3740

Provider Business Practice Location Address
First Line	:	1419 FOREST DR
Second Line	:	SUITE # 205
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-1482
Country	:	US
Telephone Number	:	443-254-3737
Fax Number	:

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	02/04/2021

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