Provider Demographics
NPI:1912049339
Name:JAMPEL, SUSAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:JAMPEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BEAUFORT ROAD
Mailing Address - Street 2:#1
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2029
Mailing Address - Country:US
Mailing Address - Phone:617-522-5557
Mailing Address - Fax:
Practice Address - Street 1:1368 BEACON STREET
Practice Address - Street 2:#116
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2800
Practice Address - Country:US
Practice Address - Phone:617-522-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJAP02430Medicare ID - Type Unspecified
MAJAP02430Medicare UPIN