Provider Demographics
NPI:1093234726
Name:DUFRESNE, SUSAN (LABA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DUFRESNE
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5970
Mailing Address - Country:US
Mailing Address - Phone:508-443-0018
Mailing Address - Fax:
Practice Address - Street 1:560 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5970
Practice Address - Country:US
Practice Address - Phone:508-443-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272981103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst