Provider Demographics
NPI:1437982121
Name:POSADA MONTALVO, SUSANA I (LPA)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:I
Last Name:POSADA MONTALVO
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:POSADA MONTALVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPA
Mailing Address - Street 1:3218 TAPESTRY CIR
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2065
Mailing Address - Country:US
Mailing Address - Phone:240-502-7578
Mailing Address - Fax:
Practice Address - Street 1:2110 PRIEST BRIDGE DR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2472
Practice Address - Country:US
Practice Address - Phone:443-937-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty