Provider Demographics
NPI:1043793870
Name:FREEMAN, SUSANNE LYNNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:LYNNE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MCINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4432
Mailing Address - Country:US
Mailing Address - Phone:978-836-8660
Mailing Address - Fax:
Practice Address - Street 1:100 MCINTOSH LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-4432
Practice Address - Country:US
Practice Address - Phone:978-836-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117083-SW-LICSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty