Provider Demographics
NPI:1013104454
Name:LIVINGSTON, SUSAN J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:LIVINGSTON
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:PO BOX 1413
Mailing Address - Street 2:OUTER CAPE HEALTH SERVICES, INC.
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-1413
Mailing Address - Country:US
Mailing Address - Phone:508-240-0208
Mailing Address - Fax:508-240-0499
Practice Address - Street 1:3130 STATE HWY RTE 6
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667-7402
Practice Address - Country:US
Practice Address - Phone:508-349-3131
Practice Address - Fax:508-349-1311
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10171371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical