Healthcare Provider Details

I. General information

NPI: 1992741953
Provider Name (Legal Business Name): SUSAN LACEY WILLIAMS RN, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 MAIN STREET SUITE 3
GREENFIELD MA
01301
US

IV. Provider business mailing address

PO BOX 1002
CHARLEMONT MA
01339-1002
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-5012
  • Fax: 413-339-0148
Mailing address:
  • Phone: 413-774-5012
  • Fax: 413-339-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLICSW1023496
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number144039
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: