Provider Demographics
NPI:1124235601
Name:HASEMAN, SUSANNE S (LCMHC)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:S
Last Name:HASEMAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PAGET RD
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:NH
Mailing Address - Zip Code:03745-4302
Mailing Address - Country:US
Mailing Address - Phone:603-675-2678
Mailing Address - Fax:603-675-9176
Practice Address - Street 1:300 PAGET RD
Practice Address - Street 2:
Practice Address - City:CORNISH
Practice Address - State:NH
Practice Address - Zip Code:03745-4302
Practice Address - Country:US
Practice Address - Phone:603-675-2678
Practice Address - Fax:603-675-9176
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH672101YM0800X
VT068-0000680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health