Provider Demographics
NPI:1598147654
Name:LUNA, SUSAN PAULINE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PAULINE
Last Name:LUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NANIGIAN RD
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612
Mailing Address - Country:US
Mailing Address - Phone:774-329-5019
Mailing Address - Fax:
Practice Address - Street 1:31 NANIGIAN RD
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1030
Practice Address - Country:US
Practice Address - Phone:777-432-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor