Provider Demographics
NPI:1609363092
Name:DEARBORN, SUZANNE BATCHELDER (LICSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BATCHELDER
Last Name:DEARBORN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-523-7900
Mailing Address - Fax:617-573-3522
Practice Address - Street 1:243 CHARLES ST.
Practice Address - Street 2:SOCIAL SERVICE DEPT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2303
Practice Address - Country:US
Practice Address - Phone:617-523-7900
Practice Address - Fax:617-573-3522
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1013711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical