Provider Demographics
NPI:1790840411
Name:BERGER, SUSAN A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:BERGER
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 1:884 OLD CONNECTICUT PATH
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7752
Mailing Address - Country:US
Mailing Address - Phone:781-962-6813
Mailing Address - Fax:508-877-6555
Practice Address - Street 1:884 OLD CONNECTICUT PATH
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7752
Practice Address - Country:US
Practice Address - Phone:781-962-6813
Practice Address - Fax:508-877-6555
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000219Medicare PIN