Provider Demographics
NPI:1053635177
Name:WEILER, SUSAN J (BA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:WEILER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 SUMMER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944
Mailing Address - Country:US
Mailing Address - Phone:617-435-1222
Mailing Address - Fax:
Practice Address - Street 1:383 SUMMER STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944
Practice Address - Country:US
Practice Address - Phone:617-435-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health