Provider Demographics
NPI:1558419747
Name:HASKELL, SUSANNE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:R
Last Name:HASKELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ARROW ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5105
Mailing Address - Country:US
Mailing Address - Phone:617-939-3422
Mailing Address - Fax:617-965-0611
Practice Address - Street 1:12 ARROW ST STE 210
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5105
Practice Address - Country:US
Practice Address - Phone:617-939-3422
Practice Address - Fax:617-965-0611
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05087OtherBCBS OF MA
MAW05087OtherBCBS OF MA