Provider Demographics
NPI:1619055316
Name:BRILL, SUSAN S (APRN,BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:BRILL
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2280
Mailing Address - Country:US
Mailing Address - Phone:617-869-4458
Mailing Address - Fax:
Practice Address - Street 1:454 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-2280
Practice Address - Country:US
Practice Address - Phone:617-869-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134544163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health