Provider Demographics
NPI:1003537499
Name:WILEY, SUSAN L (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:WILEY
Suffix:
Gender:F
Credentials:LMSW-CC
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 1189
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1189
Mailing Address - Country:US
Mailing Address - Phone:207-571-3008
Mailing Address - Fax:207-571-3263
Practice Address - Street 1:199 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1508
Practice Address - Country:US
Practice Address - Phone:207-571-3008
Practice Address - Fax:207-571-3263
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC213941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical