Provider Demographics
NPI:1790832277
Name:LORD, SUSAN A (SOCIAL WORKER)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:LORD
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 CIDER HILL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5306
Mailing Address - Country:US
Mailing Address - Phone:207-363-8814
Mailing Address - Fax:
Practice Address - Street 1:393 CIDER HILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-5306
Practice Address - Country:US
Practice Address - Phone:207-363-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC51181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME019010OtherVALUE OPTIONS INSURANCE
ME034443OtherANTHEM INSURANCE