Provider Demographics
NPI:1174694715
Name:PAN, SUSAN M (MSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:PAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 OTSEGO DR
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2444
Mailing Address - Country:US
Mailing Address - Phone:703-201-2142
Mailing Address - Fax:703-476-7881
Practice Address - Street 1:1320 VINCENT PL
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3614
Practice Address - Country:US
Practice Address - Phone:703-201-2142
Practice Address - Fax:703-476-7881
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical