Provider Demographics
NPI:1598181240
Name:MOCNIAK, SUSAN MARIE (LISW, CDCA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:MOCNIAK
Suffix:
Gender:F
Credentials:LISW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 WENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2467
Mailing Address - Country:US
Mailing Address - Phone:614-354-6962
Mailing Address - Fax:
Practice Address - Street 1:500 W WILSON BRIDGE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2238
Practice Address - Country:US
Practice Address - Phone:614-721-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-14507151041C0700X
OHLCDC.141185-3101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH441540Medicare PIN