Provider Demographics
NPI:1194820373
Name:ALLEN, SUSAN E (EDD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERRIMAC ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2558
Mailing Address - Country:US
Mailing Address - Phone:978-462-7107
Mailing Address - Fax:978-462-9007
Practice Address - Street 1:1 MERRIMAC ST
Practice Address - Street 2:SUITE 16
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2558
Practice Address - Country:US
Practice Address - Phone:978-462-7107
Practice Address - Fax:978-462-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04381Medicare ID - Type UnspecifiedBCBS PROVIDER NUMBER