MEDICARE: MS. SUSAN RUCKER LCMFT

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	106H00000X	Marriage & Family Therapist	LCM 159	MD

General Provider Information

NPI Number	:	1922194356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN RUCKER LCMFT

Provider Business Mailing Address
First Line	:	CMR 470, BOX 4539
Second Line	:
City	:	APO
State	:	AE
Zip	:	09165
Country	:	US
Telephone Number	:	496181889278
Fax Number	:	496181888584

Provider Business Practice Location Address
First Line	:	USAHC HANAU
Second Line	:	UNIT 20193, BOX 0030
City	:	APO
State	:	AE
Zip	:	09165-0030
Country	:	US
Telephone Number	:	496181889278
Fax Number	:	496181888584

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/21/2022

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