Provider Demographics
NPI:1801002159
Name:SUSAN L. PERRY, LICSW, P.C.
Entity Type:Organization
Organization Name:SUSAN L. PERRY, LICSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:I
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-979-8300
Mailing Address - Street 1:388 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-4992
Mailing Address - Country:US
Mailing Address - Phone:508-979-8300
Mailing Address - Fax:
Practice Address - Street 1:388 COUNTY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4992
Practice Address - Country:US
Practice Address - Phone:508-979-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0004765Medicare PIN