Provider Demographics
NPI:1275700965
Name:AUSTIN, SUSAN R (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 N HIGH ST
Mailing Address - Street 2:TRI COUNTY MENTAL HEALTH SERVICES
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-1125
Mailing Address - Country:US
Mailing Address - Phone:207-647-5629
Mailing Address - Fax:207-647-5620
Practice Address - Street 1:32 N HIGH ST
Practice Address - Street 2:TRI COUNTY MENTAL HEALTH SERVICES
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1125
Practice Address - Country:US
Practice Address - Phone:207-647-5629
Practice Address - Fax:207-647-5620
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC53081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical