Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW001190 | GA |
NPI | 1003163981 |
---|---|
Provider Name | Ms. Susan Peterson-Hazan |
First Address | Atlanta, GA 30329-4021 |
Second Address | Atlanta, GA 30329-4021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2012 |
Last Update Date | 09/08/2012 |