Provider Demographics
NPI:1831315126
Name:ELLIOTT, SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:ELLIOTT
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 1:162 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3248
Mailing Address - Country:US
Mailing Address - Phone:978-745-2440
Mailing Address - Fax:978-745-7615
Practice Address - Street 1:162 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3248
Practice Address - Country:US
Practice Address - Phone:978-745-2440
Practice Address - Fax:978-745-7615
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10265081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical