Provider Demographics
NPI:1013928696
Name:PHILIBERT, SUSANNA M (LICSW, LCDP)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:M
Last Name:PHILIBERT
Suffix:
Gender:F
Credentials:LICSW, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1602
Mailing Address - Country:US
Mailing Address - Phone:401-246-1195
Mailing Address - Fax:
Practice Address - Street 1:EAST BAY MENTAL HEALTH CENTER
Practice Address - Street 2:2 OLD COUNTY ROAD
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806
Practice Address - Country:US
Practice Address - Phone:401-246-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00050101YA0400X
RI1SW01479104100000X
RIISW014791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
41006OtherBLUE CHIP
264772OtherBLUE CROSS
62-47775OtherUBH
41006OtherBLUE CHIP