Provider Demographics
NPI:1689693608
Name:CETLIN, SUSAN P (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:CETLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-0354
Mailing Address - Country:US
Mailing Address - Phone:781-724-1189
Mailing Address - Fax:
Practice Address - Street 1:450 N MAIN ST
Practice Address - Street 2:450 EXECUTIVE SUITES
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-0354
Practice Address - Country:US
Practice Address - Phone:781-724-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4053103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent