1790886752 NPI number — MISS SUSAN A. WANGERMAN MA, LSW, LMHC

Table of content: SARAH PATTERSON (NPI 1366977209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790886752 NPI number — MISS SUSAN A. WANGERMAN MA, LSW, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANGERMAN
Provider First Name:
SUSAN
Provider Middle Name:
A.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA, LSW, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERSON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
WANGERMAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790886752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLEANS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02653-6366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-255-3866
Provider Business Mailing Address Fax Number:
508-255-3790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CHASE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLEANS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02653-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-255-3866
Provider Business Practice Location Address Fax Number:
508-255-3790
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4068 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 3025778 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BC/BS OF MA . This is a "ALL PRODUCTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1895052 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 354857 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 454542 . This is a "TUFTS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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