Healthcare Provider Details

I. General information

NPI: 1366168239
Provider Name (Legal Business Name): SUSANNAH SHERMAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 COOLIDGE AVE
MANCHESTER NH
03102-3493
US

IV. Provider business mailing address

14254 DR MARTIN LUTHER KING JR BLVD
DOVER FL
33527-4414
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0005
  • Fax: 603-883-0007
Mailing address:
  • Phone: 813-653-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20481
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5725
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: