1841351251 NPI number — SUZAN E WOLPOW M.S., LMHC, LRC, CRC

Table of content: SUZAN E WOLPOW M.S., LMHC, LRC, CRC (NPI 1841351251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841351251 NPI number — SUZAN E WOLPOW M.S., LMHC, LRC, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLPOW
Provider First Name:
SUZAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., LMHC, LRC, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOLPOW-GILL
Provider Other First Name:
SUZAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., LMHC, LRC, CRC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841351251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SHERMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02140-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-441-0758
Provider Business Mailing Address Fax Number:
617-491-1938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SHERMAN ST
Provider Second Line Business Practice Location Address:
REAR
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02140-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-441-0758
Provider Business Practice Location Address Fax Number:
617-491-1938
Provider Enumeration Date:
12/12/2006

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: 101Y00000X , with the licence number:  LRC 90 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: LMHC 211 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 892528 . This is a "MASS BEHAVIORAL HEALTH PL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: LM0137 . This is a "BCBSOF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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