Basic Information
| Provider Information | |||||||||
| NPI: | 1558375394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 BURNET AVENUE | ||||||||
| Address2: | 1 RIDGEWAY | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135859009 | ||||||||
| FaxNumber: | 5135859373 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 PARK AVENUE | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138670676 | ||||||||
| FaxNumber: | 5138670762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10001960 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.