1609176403 NPI number — SUZANNE ROWE WINTNER LICSW, MSW

Table of content: SUZANNE ROWE WINTNER LICSW, MSW (NPI 1609176403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609176403 NPI number — SUZANNE ROWE WINTNER LICSW, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINTNER
Provider First Name:
SUZANNE
Provider Middle Name:
ROWE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEPAGE
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609176403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 HALL AVE
Provider Second Line Business Mailing Address:
SOMERVILLE MENTAL HEALTH ASSOCIATION ADULT SERVICES
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02144-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-623-3278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 HALL AVE
Provider Second Line Business Practice Location Address:
SOMERVILLE MENTAL HEALTH ASSOCIATION ADULT SERVICES
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02144-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-623-3278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2010

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 , with the licence number:  113997 , 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)





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