1730154741 NPI number — MRS. SUE FURTADO LICSW

Table of content: MRS. SUE FURTADO LICSW (NPI 1730154741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730154741 NPI number — MRS. SUE FURTADO LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FURTADO
Provider First Name:
SUE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FURTADO
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730154741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97 MIDWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANSEA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-678-3774
Provider Business Mailing Address Fax Number:
508-567-4719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 MIDWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWANSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-678-3774
Provider Business Practice Location Address Fax Number:
508-567-4719
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730154741 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 415137 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7C87510 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1219720 . This is a "BEACON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 81951 . This is a "MEDICARE TIN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1858912 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6248809 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P08101 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 406420 . This is a "MBH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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