Provider Demographics
NPI:1245894583
Name:WORCESTER, SUSAN EMILY (LMSW-CC, CADC, CCS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EMILY
Last Name:WORCESTER
Suffix:
Gender:F
Credentials:LMSW-CC, CADC, CCS
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 2173
Mailing Address - Street 2:
Mailing Address - City:SO PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04116-2173
Mailing Address - Country:US
Mailing Address - Phone:207-200-6119
Mailing Address - Fax:
Practice Address - Street 1:29 ELIOT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5919
Practice Address - Country:US
Practice Address - Phone:207-200-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC17656101YM0800X
MEMC14656104100000X
MELC7008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker