Provider Demographics
NPI:1295937217
Name:ANDERSON, SUSAN (MED CAGS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MANCHESTER RD STE 11A
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-3065
Mailing Address - Country:US
Mailing Address - Phone:603-571-0577
Mailing Address - Fax:603-965-3821
Practice Address - Street 1:74 BYPASS 28
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-571-0577
Practice Address - Fax:603-965-3821
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH930101YM0800X
NH107106H00000X
MA1289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health