Provider Demographics
NPI:1437226040
Name:GULICK, SUSAN PATRICIA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PATRICIA
Last Name:GULICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BOLTWOOD WALK
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2155
Mailing Address - Country:US
Mailing Address - Phone:413-256-8304
Mailing Address - Fax:413-587-3270
Practice Address - Street 1:30 BOLTWOOD WALK
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2155
Practice Address - Country:US
Practice Address - Phone:413-256-8304
Practice Address - Fax:413-587-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018016104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGU-P05467Medicare ID - Type UnspecifiedMEDICARE B