Provider Demographics
NPI:1558987065
Name:WILCOX, SUSAN D (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PINE HAVEN SHORES RD STE 1000A
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7812
Mailing Address - Country:US
Mailing Address - Phone:413-489-2233
Mailing Address - Fax:
Practice Address - Street 1:229 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6589
Practice Address - Country:US
Practice Address - Phone:802-242-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2266091041C0700X
VT089.01354621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical