Provider Demographics
NPI:1558457879
Name:OLNEY-DUBINSKY, SUSAN M (MSW, LICSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:OLNEY-DUBINSKY
Suffix:
Gender:F
Credentials:MSW, LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POND ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1139
Mailing Address - Country:US
Mailing Address - Phone:774-307-9150
Mailing Address - Fax:
Practice Address - Street 1:25 POND ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1139
Practice Address - Country:US
Practice Address - Phone:774-307-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04211Medicare UPIN