Provider Demographics
NPI:1538235825
Name:DEAKYNE, SUSAN LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LOUISE
Last Name:DEAKYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LOUISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2870 BRITTANIA COURT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2251
Mailing Address - Country:US
Mailing Address - Phone:775-741-0973
Mailing Address - Fax:775-384-6507
Practice Address - Street 1:305 STEWART STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1606
Practice Address - Country:US
Practice Address - Phone:775-741-0973
Practice Address - Fax:775-384-6507
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL38651041C0700X
NV5322-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36810Medicare UPIN
CAZZZ38844ZMedicare ID - Type Unspecified