Provider Demographics
NPI:1821139916
Name:GERE, SUSAN HAZEL (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HAZEL
Last Name:GERE
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MASSACHUSETTS AVE STE 24
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3070
Mailing Address - Country:US
Mailing Address - Phone:617-547-8135
Mailing Address - Fax:617-547-8135
Practice Address - Street 1:875 MASSACHUSETTS AVE STE 24
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3070
Practice Address - Country:US
Practice Address - Phone:617-547-8135
Practice Address - Fax:617-547-8135
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1000951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical