Healthcare Provider Details

I. General information

NPI: 1376654038
Provider Name (Legal Business Name): SUSAN HAYES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SHADOW BROOK EST
SOUTH HADLEY MA
01075-2675
US

IV. Provider business mailing address

75 SHADOW BROOK EST
SOUTH HADLEY MA
01075-2675
US

V. Phone/Fax

Practice location:
  • Phone: 413-727-2774
  • Fax:
Mailing address:
  • Phone: 413-727-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113401
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: