Provider Demographics
NPI:1083872188
Name:SUZANNE GOLDBERG LLC
Entity Type:Organization
Organization Name:SUZANNE GOLDBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-388-0606
Mailing Address - Street 1:5 MARKET SQ
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2497
Mailing Address - Country:US
Mailing Address - Phone:978-388-0606
Mailing Address - Fax:978-388-0006
Practice Address - Street 1:5 MARKET SQ
Practice Address - Street 2:SUITE 206
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2497
Practice Address - Country:US
Practice Address - Phone:978-388-0606
Practice Address - Fax:978-388-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02801Medicare PIN