Provider Demographics
NPI:1023092079
Name:VINCENT, SUSAN A (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-0604
Mailing Address - Country:US
Mailing Address - Phone:508-991-4404
Mailing Address - Fax:508-996-4862
Practice Address - Street 1:3 N ORCHARD ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3661
Practice Address - Country:US
Practice Address - Phone:508-991-4404
Practice Address - Fax:508-996-4862
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA104967OtherMAGELLAN
MA755196OtherTUFTS HEALTH PLAN
MA1890492Medicaid
MA755196OtherTUFTS HEALTH PLAN