Healthcare Provider Details

I. General information

NPI: 1639371768
Provider Name (Legal Business Name): SUSAN LYNNE HARTNETT MSW LCSW ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 POST RD SUITE 7 KRAEMER BLDG
WARWICK RI
02886-3176
US

IV. Provider business mailing address

3521 POST RD # B
WAKEFIELD RI
02879-7573
US

V. Phone/Fax

Practice location:
  • Phone: 401-595-6170
  • Fax: 401-789-3059
Mailing address:
  • Phone: 401-789-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW01156
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number436
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01982
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number058564
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: