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NPI Code Detail

MEDICARE: MS. SUSAN WEINBERG LICSW

MEDICARE: MS. SUSAN WEINBERG 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
1101YM0800XMental Health Counselor1024550MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
194172OTHERMACIGNA BEHAVIORAL HEALTH
2P08376OTHERMABLUE CROSS BLUE SHIELD
3028054OTHERMAVALUE OPTIONS
431643OTHERMAHEALTH NEW ENGLAND

General Provider Information

NPI Number : 1861569808
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN WEINBERG LICSW
Provider Business Mailing Address
First Line : 7 WATER ST
Second Line :
City : HOUSATONIC
State : MA
Zip : 01236-9761
Country : US
Telephone Number : 413-274-0006
Fax Number :
Provider Business Practice Location Address
First Line : 333 EAST ST
Second Line : BRIEN CENTER
City : PITTSFIELD
State : MA
Zip : 01201-5312
Country : US
Telephone Number : 413-629-1180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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