Provider Demographics
NPI:1356387385
Name:SHULMAN, SUSAN C (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3913
Mailing Address - Country:US
Mailing Address - Phone:781-648-4574
Mailing Address - Fax:617-484-4531
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6531
Practice Address - Country:US
Practice Address - Phone:781-648-4574
Practice Address - Fax:617-484-2549
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1852426Medicaid
MAPO1143Medicare ID - Type UnspecifiedMEDICARE