Provider Demographics
NPI:1689775124
Name:SAWYER, SUSAN D (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:SAWYER
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 1:15 SHEFFIELD W
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3526
Mailing Address - Country:US
Mailing Address - Phone:781-721-1476
Mailing Address - Fax:
Practice Address - Street 1:55 CAMBRIDGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4615
Practice Address - Country:US
Practice Address - Phone:781-221-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1061571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21384Medicare ID - Type Unspecified