1780282335 NPI number — SUSAN M WARREN LMHC

Table of content: SUSAN M WARREN LMHC (NPI 1780282335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780282335 NPI number — SUSAN M WARREN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780282335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 SIDERS POND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02540-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-259-5294
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARTHA'S VINEYARD COMMUNITY SERVICES
Provider Second Line Business Practice Location Address:
111 EDGARTOWN RD
Provider Business Practice Location Address City Name:
OAK BLUFFS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-693-7900
Provider Business Practice Location Address Fax Number:
508-693-7192
Provider Enumeration Date:
10/15/2020

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: 101YM0800X , with the licence number:  LMHC10001311 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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