Provider Demographics
NPI:1770794661
Name:SUSAN RANDLETT ACSW, DCSW, LLC
Entity type:Organization
Organization Name:SUSAN RANDLETT ACSW, DCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RANDLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:603-456-2004
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:NH
Mailing Address - Zip Code:03278-0048
Mailing Address - Country:US
Mailing Address - Phone:603-456-2004
Mailing Address - Fax:
Practice Address - Street 1:19 EAST MAIN ST.
Practice Address - Street 2:STE. 2
Practice Address - City:WARNER
Practice Address - State:NH
Practice Address - Zip Code:03278
Practice Address - Country:US
Practice Address - Phone:603-456-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH433251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2038681OtherCIGNA
NH30423160Medicaid
NH14Y007920NH01OtherANTHEM
NH14Y007920NH01OtherANTHEM