Provider Demographics
NPI:1669126652
Name:SUSAN P HANEWALD
Entity type:Organization
Organization Name:SUSAN P HANEWALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HANEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-356-6565
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05085-0081
Mailing Address - Country:US
Mailing Address - Phone:802-356-6565
Mailing Address - Fax:
Practice Address - Street 1:1341 TUCKER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:VT
Practice Address - Zip Code:05051-9668
Practice Address - Country:US
Practice Address - Phone:802-356-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty