Provider Demographics
NPI:1730154741
Name:FURTADO, SUE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:
Last Name:FURTADO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FURTADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LICSW
Mailing Address - Street 1:97 MIDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777
Mailing Address - Country:US
Mailing Address - Phone:508-678-3774
Mailing Address - Fax:508-567-4719
Practice Address - Street 1:97 MIDWOOD DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777
Practice Address - Country:US
Practice Address - Phone:508-678-3774
Practice Address - Fax:508-567-4719
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1730154741OtherBCBSRI
MA415137OtherTUFTS
MA7C87510OtherAETNA
MA1219720OtherBEACON
MA81951OtherMEDICARE TIN
MA1858912Medicaid
6248809OtherUBH
MAP08101OtherBCBS
MA406420OtherMBH
MAP08101OtherBCBS