Healthcare Provider Details

I. General information

NPI: 1821467259
Provider Name (Legal Business Name): SUZANNE LYNNE MACALUSO LICSW, LADC1, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VERTAVA HEALTH 151 SOUTH STREET
CUMMINGTON MA
01026
US

IV. Provider business mailing address

50 STANIFORD ST FL 9
BOSTON MA
02114-2506
US

V. Phone/Fax

Practice location:
  • Phone: 413-200-7511
  • Fax:
Mailing address:
  • Phone: 617-724-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: