Provider Demographics
NPI:1518046929
Name:PATCHEN, SUSAN J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:PATCHEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LOCKELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6342
Mailing Address - Country:US
Mailing Address - Phone:781-640-8356
Mailing Address - Fax:781-416-4321
Practice Address - Street 1:42 WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1803
Practice Address - Country:US
Practice Address - Phone:781-235-2581
Practice Address - Fax:781-416-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA-P21063Medicare ID - Type Unspecified
MA461728Medicare UPIN
MAP02780Medicare UPIN