Provider Demographics
NPI:1033693106
Name:OLIVER, SUSAN BEAVAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BEAVAN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 AMERICAN LEGION HWY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4100
Mailing Address - Country:US
Mailing Address - Phone:774-762-3280
Mailing Address - Fax:
Practice Address - Street 1:519 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4100
Practice Address - Country:US
Practice Address - Phone:774-309-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical