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General NPI Number Information
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NPI Number | 1609917616
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Entity Type | Individual
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Provider Name | SUSAN RIVCHUN LAGER LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/11/2007
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 118 MAPLEWOOD AVE BUILDING A
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City | PORTSMOUTH
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State | NH
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Zip | 03801-3787
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Country | US
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Telephone | 603-431-7131
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Fax | 603-439-4113
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Provider Business Mailing Address
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Address Line | 270 ROLLINGWOOD RD
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City | ELIOT
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State | ME
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Zip | 03903-1525
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Country | US
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Telephone | 207-439-3330
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Fax | 207-439-4113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 202
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License Number State | NH
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