Healthcare Provider Details

I. General information

NPI: 1982187506
Provider Name (Legal Business Name): SUSAN A. HAAS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WATER ST
DANVERS MA
01923-4103
US

IV. Provider business mailing address

37 HOLTEN ST APT 10
DANVERS MA
01923-1933
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-0445
  • Fax:
Mailing address:
  • Phone: 978-539-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113169
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: