Provider Demographics
NPI:1003207713
Name:SYLVIA, SUSANNA (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:BOLGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-679-5222
Mailing Address - Fax:508-676-5671
Practice Address - Street 1:386 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-679-5222
Practice Address - Fax:508-676-5671
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120255101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor