Provider Demographics
NPI:1740276526
Name:CHARKOUDIAN, SUSAN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CHARKOUDIAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PHEASANT HILL LN
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1561
Mailing Address - Country:US
Mailing Address - Phone:978-371-1506
Mailing Address - Fax:978-371-1506
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-251-9544
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1037031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical