Provider Demographics
NPI:1902972888
Name:DROE-PUNZO, SUSAN JANE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JANE
Last Name:DROE-PUNZO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:DROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3438 ASHLAND AVENUE
Mailing Address - Street 2:SUITE X
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-752-8196
Mailing Address - Fax:816-364-2725
Practice Address - Street 1:3438 ASHLAND AVENUE
Practice Address - Street 2:SUITE X
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-752-8196
Practice Address - Fax:816-364-2725
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
R922963Medicare ID - Type Unspecified