Susan Lynn Dimock, LCSW
Individual provider Active NPI Clinical Social Worker · Bandon, OR
NPI 1619098167 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1619098167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- L3672 (OR)
- Practice address
- 1212 Alabama St
Suite 27
Bandon, OR 97411 - Phone
- (541) 347-7090
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L3672 | OR | MD | Clinical Social Worker |
| 3672 | OR | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L3672 | OR | Yes |
Addresses
Primary practice location
1212 Alabama St
Suite 27
Bandon, OR 97411
Mailing address
PO Box 252
Bandon, OR 97411-0252
Phone (541) 347-7090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J015501 | Other | OR | PACIFIC SOURCE ID NUMBER |
Other providers in Bandon, OR
- Canada Converse
- Coos County School District 54
- Coos Eye Centers, Inc.
- Daniel James Desurra
- John Dimaggio
- Anna Delaine Dodd
- Douglas Medical Equipment Supply
- Richard Charles Dowling Jr.
- Kirsten Cassidy Dugan
- Rachel Lee Dugan
All providers in Bandon, OR · Clinical Social Worker in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.