Provider Demographics
NPI:1730274119
Name:NORMAN, SUSAN E (LICSW, BCD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 THREE RIVERS FARM RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5106
Mailing Address - Country:US
Mailing Address - Phone:603-749-3331
Mailing Address - Fax:603-749-3331
Practice Address - Street 1:53 LANGLEY ROAD
Practice Address - Street 2:SUITE 280
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-964-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW102750-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02890OtherBCBS
MA703969OtherTUFTS HEALTH PLAN
MAP21049Medicare ID - Type Unspecified