Provider Demographics
NPI:1093001570
Name:JIMERSON, SUSAN L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:JIMERSON
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 1:50 LONG POND DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-4180
Mailing Address - Country:US
Mailing Address - Phone:508-760-1475
Mailing Address - Fax:
Practice Address - Street 1:50 LONG POND DR
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-4180
Practice Address - Country:US
Practice Address - Phone:508-760-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health