Provider Demographics
NPI:1679640452
Name:STANHOPE, SUSAN F (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:STANHOPE
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 1:18 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-7808
Mailing Address - Country:US
Mailing Address - Phone:401-742-1765
Mailing Address - Fax:
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-742-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW011611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
140001161RI01OtherANTHEM
140001161RI02OtherANTHEM
RI22351-9OtherBLUE CROSS
308018OtherMHN
359528500OtherOFFICE OF WORKERS COMP
RI407818OtherBLUE CHIP COORDINATED HEA
62-48888OtherUNITED BEHAVIORAL HEALTH
IP308353OtherMAGELLAN HEALTH SERVICES
1020660OtherBECON HEALTH STRATEGIES
RI407818OtherBLUE CHIP COORDINATED HEA
359528500OtherOFFICE OF WORKERS COMP
1020660OtherBECON HEALTH STRATEGIES