Provider Demographics
NPI:1851893218
Name:BROCK, SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BROCK
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 1:296 BIRNAM RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01360-1151
Mailing Address - Country:US
Mailing Address - Phone:413-498-2120
Mailing Address - Fax:
Practice Address - Street 1:296 BIRNAM RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01360-1151
Practice Address - Country:US
Practice Address - Phone:413-498-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1063971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical