Provider Demographics
NPI:1780282335
Name:WARREN, SUSAN M (LMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WARREN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SIDERS POND RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2665
Mailing Address - Country:US
Mailing Address - Phone:508-259-5294
Mailing Address - Fax:
Practice Address - Street 1:MARTHA'S VINEYARD COMMUNITY SERVICES
Practice Address - Street 2:111 EDGARTOWN RD
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:508-693-7192
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10001311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty