Healthcare Provider Details

I. General information

NPI: 1124425897
Provider Name (Legal Business Name): SUSAN D GERSHWIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MAINE AVE
EASTHAMPTON MA
01027-1595
US

IV. Provider business mailing address

43632 MODENA DR
TEMECULA CA
92592-9241
US

V. Phone/Fax

Practice location:
  • Phone: 857-753-6631
  • Fax:
Mailing address:
  • Phone: 857-753-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116959
License Number StateMA

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: