Healthcare Provider Details

I. General information

NPI: 1932265113
Provider Name (Legal Business Name): SUSAN H ETKIND LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 LINCOLN ST SUITE 210
HINGHAM MA
02043-1760
US

IV. Provider business mailing address

PO BOX 638
COHASSET MA
02025-0638
US

V. Phone/Fax

Practice location:
  • Phone: 781-740-2699
  • Fax: 781-923-1176
Mailing address:
  • Phone: 781-740-2699
  • Fax: 781-923-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100682
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: