Provider Demographics
NPI:1033263470
Name:ROUSE, SUSAN JEAN (RN,CS, MS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JEAN
Last Name:ROUSE
Suffix:
Gender:F
Credentials:RN,CS, MS
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:JEAN
Other - Last Name:BULENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CS MS
Mailing Address - Street 1:26 ARBORVIEW RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3419
Mailing Address - Country:US
Mailing Address - Phone:781-330-9865
Mailing Address - Fax:
Practice Address - Street 1:300 LINDEN PONDS WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3769
Practice Address - Country:US
Practice Address - Phone:781-534-7100
Practice Address - Fax:781-534-7358
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145988364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP9437OtherBSBC MA
83-06424OtherEVERCARE
83-06424OtherEVERCARE
NP9437OtherBSBC MA