Provider Demographics
NPI:1568597524
Name:CHERNOV, SUSAN JOY (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOY
Last Name:CHERNOV
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 1:2 RICHMOND SQ
Mailing Address - Street 2:103
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5100
Mailing Address - Country:US
Mailing Address - Phone:401-831-2763
Mailing Address - Fax:
Practice Address - Street 1:2 RICHMOND SQ
Practice Address - Street 2:103
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5100
Practice Address - Country:US
Practice Address - Phone:401-831-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical