Provider Demographics
NPI:1992791768
Name:REED, SUSAN R (MSSW, LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:REED
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RENEE REED
Other - Last Name:DALRYMPLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3939 W GREEN OAKS BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2793
Mailing Address - Country:US
Mailing Address - Phone:817-933-4878
Mailing Address - Fax:
Practice Address - Street 1:3939 W GREEN OAKS BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2793
Practice Address - Country:US
Practice Address - Phone:817-933-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX268391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB153033OtherMEDICARE PTAN
TX26839OtherLCSW
MSC7309OtherSTATE LICENSE