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NPI Code Detail

MEDICARE: SUSAN HILLIS LICSW

MEDICARE: SUSAN HILLIS LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker206257MA

General Provider Information

NPI Number : 1063562692
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN HILLIS LICSW
Provider Business Mailing Address
First Line : 107 LINCOLN ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2401
Country : US
Telephone Number : 508-453-3041
Fax Number : 508-753-3733
Provider Business Practice Location Address
First Line : 107 LINCOLN ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2401
Country : US
Telephone Number : 508-453-3041
Fax Number : 508-753-3733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/08/2007

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Directions to “ SUSAN HILLIS LICSW” Practice Location

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