Provider Demographics
NPI:1912098427
Name:HUPFER, SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HUPFER
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 1:1 DAVID HENRY GARDNER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01772
Mailing Address - Country:US
Mailing Address - Phone:978-742-9799
Mailing Address - Fax:508-486-0082
Practice Address - Street 1:9 ACTON ROAD
Practice Address - Street 2:SUITE 24
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824
Practice Address - Country:US
Practice Address - Phone:978-742-9799
Practice Address - Fax:508-486-0082
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06646Medicare ID - Type Unspecified