Healthcare Provider Details

I. General information

NPI: 1720002025
Provider Name (Legal Business Name): SUSAN NASH WOODWARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 PROSPECT AVE MANCHESTER MEMORIAL HOSPITAL
HARTFORD CT
06105-4238
US

IV. Provider business mailing address

66 ADAMS RD
BLOOMFIELD CT
06002-1134
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-3494
  • Fax:
Mailing address:
  • Phone: 860-550-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003897
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: