Provider Demographics
NPI:1942337852
Name:STILLWELL, SUSAN ANGELA (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANGELA
Last Name:STILLWELL
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 1:219 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4100
Mailing Address - Country:US
Mailing Address - Phone:781-662-5267
Mailing Address - Fax:617-227-5447
Practice Address - Street 1:219 LAUREL ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-4100
Practice Address - Country:US
Practice Address - Phone:781-662-5267
Practice Address - Fax:617-227-5447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical