Provider Demographics
NPI:1821271198
Name:TIBEIJUKA, SUSAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:TIBEIJUKA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HIGHLAND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3023
Mailing Address - Country:US
Mailing Address - Phone:781-449-1884
Mailing Address - Fax:781-449-7972
Practice Address - Street 1:255 HIGHLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3023
Practice Address - Country:US
Practice Address - Phone:781-449-1884
Practice Address - Fax:781-449-7972
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker