Healthcare Provider Details

I. General information

NPI: 1730274119
Provider Name (Legal Business Name): SUSAN E. NORMAN LICSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 LANGLEY ROAD SUITE 280
NEWTON CENTRE MA
02459
US

IV. Provider business mailing address

41 THREE RIVERS FARM RD
DOVER NH
03820-5106
US

V. Phone/Fax

Practice location:
  • Phone: 617-964-2622
  • Fax:
Mailing address:
  • Phone: 603-749-3331
  • Fax: 603-749-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW102750-1
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP02890
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS
# 2
Identifier703969
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: