Provider Demographics
NPI:1255478830
Name:GARRETT, SUSAN E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:GARRETT
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 1:5 LAURANA LN
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9740
Mailing Address - Country:US
Mailing Address - Phone:413-549-6223
Mailing Address - Fax:
Practice Address - Street 1:5 LAURANA LN
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9740
Practice Address - Country:US
Practice Address - Phone:413-549-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10169901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05487Medicare ID - Type Unspecified