Provider Demographics
NPI:1396149472
Name:NEWMAN, SUSAN SYDNEY (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SYDNEY
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:66 ARUNDEL PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2278
Mailing Address - Country:US
Mailing Address - Phone:314-378-0312
Mailing Address - Fax:
Practice Address - Street 1:745 CRAIG RD
Practice Address - Street 2:STE 212
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7160
Practice Address - Country:US
Practice Address - Phone:314-395-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0021751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical