Healthcare Provider Details

I. General information

NPI: 1881751782
Provider Name (Legal Business Name): SUSAN KERSHAW-SCZUROSKI LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MAIN ST
DANIELSON CT
06239-2816
US

IV. Provider business mailing address

PO BOX 410
POMFRET CTR CT
06259-0410
US

V. Phone/Fax

Practice location:
  • Phone: 401-935-3824
  • Fax:
Mailing address:
  • Phone: 401-935-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISWO1270
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009127
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: