MEDICARE: SUSAN RESNICK 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
1	1041C0700X	Clinical Social Worker	CSW03021	RI

General Provider Information

NPI Number	:	1366272908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN RESNICK LICSW

Provider Business Mailing Address
First Line	:	162 CAMDEN RD
Second Line	:
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-2123
Country	:	US
Telephone Number	:	617-697-6575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 KINGSTOWN RD
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-7909
Country	:	US
Telephone Number	:	401-789-9390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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Directions to “ SUSAN RESNICK LICSW” Practice Location

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