Provider Demographics
NPI:1891843066
Name:AESCHBACH, SUSAN ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:AESCHBACH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:AESCHBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:185 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1734
Mailing Address - Country:US
Mailing Address - Phone:617-527-2613
Mailing Address - Fax:
Practice Address - Street 1:185 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1734
Practice Address - Country:US
Practice Address - Phone:617-527-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1001691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1519OtherBLUE CROSS BLUE SHIELD