Provider Demographics
NPI:1750503058
Name:SMITH-SCOTT, SUSAN (LICSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SMITH-SCOTT
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 283
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-0283
Mailing Address - Country:US
Mailing Address - Phone:508-832-4101
Mailing Address - Fax:
Practice Address - Street 1:250 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2584
Practice Address - Country:US
Practice Address - Phone:508-832-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10167291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA732802OtherTUFTS
MAPO6214OtherBLUE CROSS BLUE SHIELD
MT22587OtherMAGELLAN