Provider Demographics
NPI:1932275104
Name:PETERSON, SUSAN W (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:W
Last Name:PETERSON
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 1:575 BEECH ST
Mailing Address - Street 2:HOLYOKE MEDICAL CENTER OUTPATIENT SERVICE
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2223
Mailing Address - Country:US
Mailing Address - Phone:413-534-2785
Mailing Address - Fax:413-534-2659
Practice Address - Street 1:575 BEECH ST
Practice Address - Street 2:HOLYOKE MEDICAL CENTER OUTPATIENT SERVICE
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2223
Practice Address - Country:US
Practice Address - Phone:413-534-2785
Practice Address - Fax:413-534-2659
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10229141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical