Individual provider Active NPI

Susanne Derr Bock, LSW

  • Social Worker
  • Marietta, OH
National Provider Identifier
1053648519
Registry record updated Nov 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S.0029273 Issued in OH
Practice address
207 Colegate Dr
Marietta, OH 45750-2363
Phone
(740) 376-0930
Fax
(740) 376-0933
NPI assigned
Nov 4, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X S.0029273 OH Primary

Addresses

Primary practice location

207 Colegate Dr
Marietta, OH 45750-2363

Mailing address

108 Merryhill St
Marietta, OH 45750-1366

Other names 1

  • Suzanne Derr Contino Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
S.0029273OHMDSocial Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257292800000",
    "number": "1053648519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 MERRYHILL ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 COLEGATE DR",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457502363",
            "telephone_number": "740-376-0930",
            "fax_number": "740-376-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCK",
        "first_name": "SUSANNE",
        "middle_name": "DERR",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-04",
        "last_updated": "2009-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.0029273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZANNE",
            "last_name": "CONTINO",
            "middle_name": "DERR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marietta, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.