Provider Demographics
NPI:1992741953
Name:WILLIAMS, SUSAN LACEY (RN, LICSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LACEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:CHARLEMONT
Mailing Address - State:MA
Mailing Address - Zip Code:01339-1002
Mailing Address - Country:US
Mailing Address - Phone:413-774-5012
Mailing Address - Fax:413-339-0148
Practice Address - Street 1:466 MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-774-5012
Practice Address - Fax:413-339-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1023496103T00000X
MA144039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08203OtherBCBS MA
MA32153OtherBMC HEALTHNET
MA32153OtherBMC HEALTHNET