Provider Demographics
NPI:1467505495
Name:MONTVILLE, SUSAN M (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:MONTVILLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2584
Mailing Address - Country:US
Mailing Address - Phone:508-832-4101
Mailing Address - Fax:508-248-1063
Practice Address - Street 1:250 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2584
Practice Address - Country:US
Practice Address - Phone:508-832-4101
Practice Address - Fax:508-248-1063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1020140OtherBEACON HEALTH STRATEGIES
MA1020140OtherFALLON COMMUNITY HEALTH P
MAM0P04058OtherBLUE CROSS BLUE SHIELD
MA35630OtherMAGELLAN BEHAVIORAL HEALT
MA017252OtherVALUE OPTIONS
MAM0P21872Medicare ID - Type UnspecifiedPART B