Provider Demographics
NPI:1063422418
Name:BORSTEIN, SUSAN B (MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:BORSTEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W PROSPECT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5830
Mailing Address - Country:US
Mailing Address - Phone:440-998-7541
Mailing Address - Fax:440-998-7541
Practice Address - Street 1:355 W PROSPECT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5830
Practice Address - Country:US
Practice Address - Phone:440-998-7541
Practice Address - Fax:440-998-7541
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 44771041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH214947OtherVALUE OPTIONS
OH4460062OtherAETNA
OH62-53847OtherUNITED BEHAVIORAL HEALTH
OH222904OtherCOM PSYCH
OH35795OtherCIGNA BEHAVIORAL HEALTH
OH9094234OtherPHCS
OH000000221309OtherANTHEM BLUE CROSS/BLUE SH
OH71099OtherQUAL CHOICE BEHAVIORAL HE
OH35795OtherCIGNA BEHAVIORAL HEALTH