Provider Demographics
NPI:1518539204
Name:RHEAULT, SUSANNE (PH D)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:RHEAULT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:RHEAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 OAK MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-2204
Mailing Address - Country:US
Mailing Address - Phone:781-259-0970
Mailing Address - Fax:
Practice Address - Street 1:1 OAK MEADOW RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-2204
Practice Address - Country:US
Practice Address - Phone:781-259-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist