Provider Demographics
NPI:1598212771
Name:KLUPCHAK, SUSAN ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALEXANDRA
Last Name:KLUPCHAK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 NEWTON ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-0423
Mailing Address - Country:US
Mailing Address - Phone:414-688-5494
Mailing Address - Fax:
Practice Address - Street 1:296 NEWTON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-0423
Practice Address - Country:US
Practice Address - Phone:414-688-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2218081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical