Provider Demographics
NPI:1003841487
Name:GRAESSER, SUSAN MARYDITH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARYDITH
Last Name:GRAESSER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4158
Mailing Address - Country:US
Mailing Address - Phone:781-344-0244
Mailing Address - Fax:
Practice Address - Street 1:36 WALNUT CT
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4158
Practice Address - Country:US
Practice Address - Phone:781-344-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1034471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01610OtherBLUE CROSS BLUE SHIELD
MAP01610Medicare ID - Type Unspecified