Provider Demographics
NPI:1629010103
Name:TEFFT, SUSAN K (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:TEFFT
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 1:130 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1370
Mailing Address - Country:US
Mailing Address - Phone:413-572-9900
Mailing Address - Fax:413-572-9901
Practice Address - Street 1:130 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1370
Practice Address - Country:US
Practice Address - Phone:413-572-9900
Practice Address - Fax:413-572-9901
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10262211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA026221OtherTUFTS HEALTH PLAN
MAPO8071OtherBLUE SHIELD
MAPO8071OtherBLUE SHIELD