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

Table of content: DEBORAH L HAMILL (NPI 1053371880)

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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