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NPI Code Detail

MEDICARE: SUSAN M VANETTEN LICSW

MEDICARE: SUSAN M VANETTEN LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1025683MA

General Provider Information

NPI Number : 1033409701
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M VANETTEN LICSW
Provider Business Mailing Address
First Line : PO BOX 312
Second Line :
City : WEST NEWBURY
State : MA
Zip : 01985-0412
Country : US
Telephone Number : 978-891-0264
Fax Number :
Provider Business Practice Location Address
First Line : 23 GREEN ST
Second Line :
City : NEWBURYPORT
State : MA
Zip : 01950-2652
Country : US
Telephone Number : 978-891-0264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2011
Last Update Date : 05/05/2014

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Directions to “ SUSAN M VANETTEN LICSW” Practice Location

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