Provider Demographics
NPI:1780168062
Name:HUGHES, SUSANNE D (LICSW)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:D
Last Name:HUGHES
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 1:28 HARDING LN
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2161
Mailing Address - Country:US
Mailing Address - Phone:774-237-0932
Mailing Address - Fax:
Practice Address - Street 1:28 HARDING LN
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-2161
Practice Address - Country:US
Practice Address - Phone:774-237-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA102542OtherSOCIAL WORK LICENSE