Provider Demographics
NPI:1629130737
Name:WAAS, SUZANNE MICHELLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:WAAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MICHELLE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 ATLANTIC ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1847
Mailing Address - Country:US
Mailing Address - Phone:508-789-8607
Mailing Address - Fax:
Practice Address - Street 1:460 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8130
Practice Address - Country:US
Practice Address - Phone:508-789-8607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health