Provider Demographics
NPI:1477732824
Name:TODD, SUSAN A (LIC AC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:TODD
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1418
Mailing Address - Country:US
Mailing Address - Phone:508-587-2693
Mailing Address - Fax:
Practice Address - Street 1:455 W CENTER ST # A
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1637
Practice Address - Country:US
Practice Address - Phone:508-587-2693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist