Provider Demographics
NPI:1376604645
Name:GORDON-SCHIOWITZ, SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GORDON-SCHIOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RACHEL
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:70 FRANCIS ST
Mailing Address - Street 2:BRIGHAM CIRCLE MEDICAL ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6134
Mailing Address - Country:US
Mailing Address - Phone:857-307-4135
Mailing Address - Fax:
Practice Address - Street 1:70 FRANCIS ST
Practice Address - Street 2:BRIGHAM CIRCLE MEDICAL ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6134
Practice Address - Country:US
Practice Address - Phone:857-307-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1166871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413326OtherBLUECHIP
RI31220-8OtherBLUE CROSS BLUE SHIELD OF