Provider Demographics
NPI:1114132081
Name:DUBOIS, SUSAN RAE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RAE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HEALTH CLINIC NEW ENGLAND
Mailing Address - Street 2:43 SMITH ROAD
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841
Mailing Address - Country:US
Mailing Address - Phone:401-841-4475
Mailing Address - Fax:
Practice Address - Street 1:43 SMITH RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02842-1020
Practice Address - Country:US
Practice Address - Phone:401-841-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1115103TC0700X
MA8175103T00000X
NH1097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist