Provider Demographics
NPI:1750983300
Name:SUSANNA SYLVIA LICSW LLC
Entity type:Organization
Organization Name:SUSANNA SYLVIA LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SYLVIA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:339-368-8487
Mailing Address - Street 1:37 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-2311
Mailing Address - Country:US
Mailing Address - Phone:339-368-8487
Mailing Address - Fax:
Practice Address - Street 1:42 HILLER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770-4023
Practice Address - Country:US
Practice Address - Phone:339-368-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALICENSEOtherLICSW