Provider Demographics
NPI:1245767698
Name:EBBS, SUSAN C (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:EBBS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WAKELAND RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2056
Mailing Address - Country:US
Mailing Address - Phone:508-479-3396
Mailing Address - Fax:
Practice Address - Street 1:1506 PROVIDENCE HWY STE 25
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4647
Practice Address - Country:US
Practice Address - Phone:617-401-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health