Healthcare Provider Details

I. General information

NPI: 1568530384
Provider Name (Legal Business Name): SUSAN WEINSTEIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SALEM GRN STE 400
SALEM MA
01970-3790
US

IV. Provider business mailing address

4 JOEL RD
MARBLEHEAD MA
01945-2712
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-0100
  • Fax: 978-745-9555
Mailing address:
  • Phone: 781-639-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1023637
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: