Provider Demographics
NPI:1801940473
Name:HAGERICH, SUSAN MICHELLE (LICSW)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:HAGERICH
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 1:130 CENTRE ST
Mailing Address - Street 2:FULLER HOUSE, SUITE 101
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-548-6316
Mailing Address - Fax:978-532-0200
Practice Address - Street 1:130 CENTRE ST
Practice Address - Street 2:FULLER HOUSE, SUITE 101
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-548-6316
Practice Address - Fax:978-532-0200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1138991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical