Provider Demographics
NPI:1831337658
Name:MOORE, SUSAN M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:CHAUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1061 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6728
Mailing Address - Country:US
Mailing Address - Phone:508-496-3336
Mailing Address - Fax:
Practice Address - Street 1:1061 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6728
Practice Address - Country:US
Practice Address - Phone:508-996-8572
Practice Address - Fax:508-991-8618
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health