Provider Demographics
NPI:1467505875
Name:SILVEIRA, SUSAN PERRY (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PERRY
Last Name:SILVEIRA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 BEACON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4821
Mailing Address - Country:US
Mailing Address - Phone:617-734-6500
Mailing Address - Fax:617-739-3510
Practice Address - Street 1:1415 BEACON ST STE 200
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4821
Practice Address - Country:US
Practice Address - Phone:617-734-6500
Practice Address - Fax:617-739-3510
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10157111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05395Medicare ID - Type Unspecified