Provider Demographics
NPI:1174628648
Name:BECKER, SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BECKER NISENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:18 CENTRAL ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2425
Mailing Address - Country:US
Mailing Address - Phone:508-942-2337
Mailing Address - Fax:508-543-2927
Practice Address - Street 1:18 CENTRAL ST
Practice Address - Street 2:SUITE 5
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2425
Practice Address - Country:US
Practice Address - Phone:508-942-2337
Practice Address - Fax:508-543-2927
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207446104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5453624OtherCIGNA
MA008626OtherHARVARD PILGRIM HC
MAP00698208OtherPALMETTO RR MEDICARE
MA799800OtherTUFTS
MAP233485Medicare PIN