MEDICARE: SUSAN LYNN MSW

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
1	101YM0800X	Mental Health Counselor	103986	MA

General Provider Information

NPI Number	:	1184675282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LYNN MSW

Provider Business Mailing Address
First Line	:	205 COLONY RD
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1255
Country	:	US
Telephone Number	:	413-794-1952
Fax Number	:	413-794-1857

Provider Business Practice Location Address
First Line	:	BRM 759 CHESTNUT STREET
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01199-0001
Country	:	US
Telephone Number	:	413-794-1857
Fax Number	:	413-794-1857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	04/21/2014

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