Provider Demographics
NPI:1831225184
Name:ANTHONY, SUZANNE J (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:J
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:J
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:16 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-1906
Mailing Address - Country:US
Mailing Address - Phone:508-633-7226
Mailing Address - Fax:508-519-2684
Practice Address - Street 1:16 ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-1906
Practice Address - Country:US
Practice Address - Phone:508-633-7226
Practice Address - Fax:508-519-2684
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2123351041C0700X
MA114168104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical