Provider Demographics
NPI:1326791351
Name:BULLIVANT, SUSAN BETH (MSW, PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:BULLIVANT
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 GOVERNORS RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03851-4757
Mailing Address - Country:US
Mailing Address - Phone:603-923-7001
Mailing Address - Fax:
Practice Address - Street 1:619 GOVERNORS RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NH
Practice Address - Zip Code:03851-4757
Practice Address - Country:US
Practice Address - Phone:603-923-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker