Provider Demographics
NPI:1851326649
Name:SMITH, SUSAN MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW,LCSW,LICSW
Mailing Address - Street 1:76 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3451
Mailing Address - Country:US
Mailing Address - Phone:978-465-3795
Mailing Address - Fax:978-465-3795
Practice Address - Street 1:76 TURKEY HILL RD
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3451
Practice Address - Country:US
Practice Address - Phone:978-465-3795
Practice Address - Fax:978-465-3795
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10281841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA62-00193OtherEVERCARE
MAP21005Medicare ID - Type Unspecified