Provider Demographics
NPI:1427116904
Name:WEST, SUSAN KAY (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:WEST
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 1:769 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3141
Mailing Address - Country:US
Mailing Address - Phone:781-444-5624
Mailing Address - Fax:
Practice Address - Street 1:30 EASTBROOK RD
Practice Address - Street 2:302
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2048
Practice Address - Country:US
Practice Address - Phone:781-329-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1070801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical