Provider Demographics
NPI:1841351251
Name:WOLPOW, SUZAN E (MS, LMHC, LRC, CRC)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:E
Last Name:WOLPOW
Suffix:
Gender:F
Credentials:MS, LMHC, LRC, CRC
Other - Prefix:
Other - First Name:SUZAN
Other - Middle Name:
Other - Last Name:WOLPOW-GILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMHC, LRC, CRC
Mailing Address - Street 1:111 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-3232
Mailing Address - Country:US
Mailing Address - Phone:617-441-0758
Mailing Address - Fax:617-491-1938
Practice Address - Street 1:111 SHERMAN ST
Practice Address - Street 2:REAR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-3232
Practice Address - Country:US
Practice Address - Phone:617-441-0758
Practice Address - Fax:617-491-1938
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALRC 90101Y00000X
MALMHC 211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA892528OtherMASS BEHAVIORAL HEALTH PL
MALM0137OtherBCBSOF MA