Provider Demographics
NPI:1609917616
Name:LAGER, SUSAN RIVCHUN (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RIVCHUN
Last Name:LAGER
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 1:270 ROLLINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1525
Mailing Address - Country:US
Mailing Address - Phone:207-439-3330
Mailing Address - Fax:207-439-4113
Practice Address - Street 1:118 MAPLEWOOD AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3787
Practice Address - Country:US
Practice Address - Phone:603-431-7131
Practice Address - Fax:603-439-4113
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1400525Y0NH01OtherPROVIDER ID# ANTHEMBCBS
MA613214400OtherFEDERAL WORKER'S COMPENSATION PROGRAM