Provider Demographics
NPI:1215070925
Name:TONNAR, SUSAN R (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:TONNAR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CHESTNUT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1447
Mailing Address - Country:US
Mailing Address - Phone:603-668-7744
Mailing Address - Fax:603-668-2605
Practice Address - Street 1:540 CHESTNUT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1447
Practice Address - Country:US
Practice Address - Phone:603-668-7744
Practice Address - Fax:603-668-2605
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1044010OtherCIGNA BEHAVIORAL HEALTH
NH1404927Y0NH01OtherBCBS
NH30422351Medicaid
NH30422351Medicaid