Provider Demographics
NPI:1407869316
Name:BLANCHARD, SUSAN CALDWELL (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CALDWELL
Last Name:BLANCHARD
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 1:11 HARBOR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-6526
Mailing Address - Country:US
Mailing Address - Phone:207-443-2541
Mailing Address - Fax:
Practice Address - Street 1:1 FRONT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2562
Practice Address - Country:US
Practice Address - Phone:207-442-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME7121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003811Medicare UPIN
MEMM4366Medicare ID - Type Unspecified