Active NPI
Susan Joan Conklin, LICSW, BCD
- Contractor
- Williamstown, MA
National Provider Identifier
1043439409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 100143
- Practice address
- 85 Hawthorne Rd
Williamstown, MA 01267-2700 - Phone
- (413) 884-4129
- Fax
- (413) 458-9181
- NPI assigned
- Apr 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 100143 | MA | Primary |
Addresses
Primary practice location
85 Hawthorne Rd
Williamstown, MA 01267-2700
Mailing address
85 Hawthorne Rd
Williamstown, MA 01267-2700
Phone (413) 884-4129
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100143 | MA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1043439409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85 HAWTHORNE RD",
"city": "WILLIAMSTOWN",
"state": "MA",
"postal_code": "012672700",
"telephone_number": "413-884-4129",
"fax_number": "413-458-9181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 HAWTHORNE RD",
"city": "WILLIAMSTOWN",
"state": "MA",
"postal_code": "012672700",
"telephone_number": "413-884-4129",
"fax_number": "413-458-9181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "SUSAN",
"middle_name": "JOAN",
"name_prefix": "Ms.",
"credential": "LICSW, BCD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MA",
"license": "100143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamstown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.