Healthcare Provider Details

I. General information

NPI: 1023092079
Provider Name (Legal Business Name): SUSAN A VINCENT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN A BELL MSW

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 N ORCHARD ST
NEW BEDFORD MA
02740-3661
US

IV. Provider business mailing address

PO BOX 604
FAIRHAVEN MA
02719-0604
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-4404
  • Fax: 508-996-4862
Mailing address:
  • Phone: 508-991-4404
  • Fax: 508-996-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106939
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: