Provider Demographics
NPI:1912069857
Name:BERGER, SUSAN ROBBINS (EDD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ROBBINS
Last Name:BERGER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SEWALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5240
Mailing Address - Country:US
Mailing Address - Phone:617-277-2497
Mailing Address - Fax:617-277-8638
Practice Address - Street 1:155 SEWALL AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5240
Practice Address - Country:US
Practice Address - Phone:617-277-2497
Practice Address - Fax:617-277-8638
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAHSP280103T00000X
MASW2030272104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
W02516Medicare ID - Type Unspecified