Provider Demographics
NPI:1649377557
Name:KING, C SUSIE (MSW)
Entity type:Individual
Prefix:MS
First Name:C
Middle Name:SUSIE
Last Name:KING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOHN ROBINSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2822
Mailing Address - Country:US
Mailing Address - Phone:978-562-9853
Mailing Address - Fax:978-562-9853
Practice Address - Street 1:112 MAIN STREET
Practice Address - Street 2:SUITE 105 NORTHBORO PSYCHIATRIC ASSOCIATES
Practice Address - City:NORTHBORO
Practice Address - State:MA
Practice Address - Zip Code:01532-1914
Practice Address - Country:US
Practice Address - Phone:508-393-7223
Practice Address - Fax:508-393-7026
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100703104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
S71276Medicare UPIN