Healthcare Provider Details

I. General information

NPI: 1013245943
Provider Name (Legal Business Name): SUZANNE M WHITE MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MAIN ST # 515
NEWFIELDS NH
03856-9998
US

IV. Provider business mailing address

PO BOX 515
NEWFIELDS NH
03856-0515
US

V. Phone/Fax

Practice location:
  • Phone: 603-244-0648
  • Fax:
Mailing address:
  • Phone: 802-868-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1041
License Number StateNH

VII. Legacy identifiers

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

# 1
Identifier30422164
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: