Provider Demographics
NPI:1083786149
Name:WELSH LOBACKI, SUZANNE MARIE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:WELSH LOBACKI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:O'REGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 DEVONSHIRE STREET SUZANNE WELSH LOBACKI LICSW
Mailing Address - Street 2:SUITE 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110
Mailing Address - Country:US
Mailing Address - Phone:508-272-3192
Mailing Address - Fax:
Practice Address - Street 1:185 DEVONSHIRE ST STE 503
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1415
Practice Address - Country:US
Practice Address - Phone:508-272-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10188291041C0700X
MASW10188291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06914OtherBLUE CROSS BLUE SHIELD
MA1018829OtherLICSW
MASW1018829OtherSOCIAL WORK
MA110142649AMedicaid