Provider Demographics
NPI:1881684579
Name:CZERNICKA, SUSAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:CZERNICKA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PURCHASE ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6355
Mailing Address - Country:US
Mailing Address - Phone:617-835-8175
Mailing Address - Fax:508-300-0206
Practice Address - Street 1:345 UNION ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3679
Practice Address - Country:US
Practice Address - Phone:617-835-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2731103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist