Provider Demographics
NPI:1992052138
Name:THOMAES, SUSAN PRIOR (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PRIOR
Last Name:THOMAES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:NEWMAN
Other - Last Name:PRIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22505 WOODROE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3410
Mailing Address - Country:US
Mailing Address - Phone:510-318-6112
Mailing Address - Fax:
Practice Address - Street 1:1430 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7928
Practice Address - Country:US
Practice Address - Phone:925-288-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64238101Y00000X
CAASW64238101YM0800X
CA99275104100000X, 1041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other