Provider Demographics
NPI:1427115450
Name:HALLOWELL, SUE GEORGE (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:GEORGE
Last Name:HALLOWELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:ELLEN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 BROADWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1840
Mailing Address - Country:US
Mailing Address - Phone:781-820-0881
Mailing Address - Fax:
Practice Address - Street 1:328 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-661-3113
Practice Address - Fax:781-643-7535
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1053561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03765OtherBLUE CROSS
MA731911OtherTUFTS