Provider Demographics
NPI:1114027240
Name:BLINN, SUSAN R (LCSW DIPLOMATE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:BLINN
Suffix:
Gender:F
Credentials:LCSW DIPLOMATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 MURRAY AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1655
Mailing Address - Country:US
Mailing Address - Phone:412-521-9442
Mailing Address - Fax:412-521-0931
Practice Address - Street 1:1824 MURRAY AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1655
Practice Address - Country:US
Practice Address - Phone:412-521-9442
Practice Address - Fax:412-521-0931
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001917L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABL701790Medicare ID - Type Unspecified