Basic Information
| Provider Information | |||||||||
| NPI: | 1407969066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITCOMB | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | NEEDY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1212 | ||||||||
| Address2: | |||||||||
| City: | WEST CHATHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026691212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089450360 | ||||||||
| FaxNumber: | 5089451978 | ||||||||
| Practice Location | |||||||||
| Address1: | 572 ROUTE 28 | ||||||||
| Address2: | |||||||||
| City: | WEST YARMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026734909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087750719 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2026869 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.