Provider Demographics
NPI:1932265113
Name:ETKIND, SUSAN H (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:ETKIND
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:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-0638
Mailing Address - Country:US
Mailing Address - Phone:781-740-2699
Mailing Address - Fax:781-923-1176
Practice Address - Street 1:185 LINCOLN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1760
Practice Address - Country:US
Practice Address - Phone:781-740-2699
Practice Address - Fax:781-923-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1006821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical