Provider Demographics
NPI:1336564806
Name:FLAHERTY, SUSANNAH HANSON (PSYD)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:HANSON
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SUSANNAH
Other - Middle Name:HANSON
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:175 FOREST STREET
Mailing Address - Street 2:MICHAEL A. CALLAHAN BUILDING, 2ND FLOOR
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:781-891-2265
Mailing Address - Fax:
Practice Address - Street 1:175 FOREST ST
Practice Address - Street 2:MICHAEL A. CALLAHAN BUILDING, 2ND FLOOR
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4713
Practice Address - Country:US
Practice Address - Phone:781-891-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist