Provider Demographics
NPI:1104042894
Name:RASHBA, SUSAN M
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:RASHBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2911
Mailing Address - Country:US
Mailing Address - Phone:781-245-5162
Mailing Address - Fax:
Practice Address - Street 1:9 FOSTER ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2911
Practice Address - Country:US
Practice Address - Phone:781-245-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARAW50499Medicare ID - Type Unspecified