Provider Demographics
NPI:1053377689
Name:MARCUM, SUSAN K (LSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:MARCUM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25708-0390
Mailing Address - Country:US
Mailing Address - Phone:304-429-1088
Mailing Address - Fax:304-696-1623
Practice Address - Street 1:936 STATE ROUTE 107
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8243
Practice Address - Country:US
Practice Address - Phone:740-446-4600
Practice Address - Fax:740-446-2944
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00222191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274068Medicaid