Provider Demographics
NPI:1346347606
Name:CRIMMINS, SUSAN C (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:STADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 FORTUNE BLVD
Mailing Address - Street 2:MILFORD
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1741
Mailing Address - Country:US
Mailing Address - Phone:508-473-7400
Mailing Address - Fax:
Practice Address - Street 1:409 FORTUNE BLVD
Practice Address - Street 2:MILFORD
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1741
Practice Address - Country:US
Practice Address - Phone:508-473-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical