Provider Demographics
NPI:1225140916
Name:STAFURSKY, SUSAN WRIGHT (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WRIGHT
Last Name:STAFURSKY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:WRIGHT
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:155 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6653
Mailing Address - Country:US
Mailing Address - Phone:802-257-9158
Mailing Address - Fax:
Practice Address - Street 1:155 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6653
Practice Address - Country:US
Practice Address - Phone:802-257-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH812633595Medicaid
NH812633595Medicaid