Provider Demographics
NPI:1932276730
Name:NADAS, SUSAN BOKOR (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BOKOR
Last Name:NADAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MASSACHUSETTS AVE STE 83
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3071
Mailing Address - Country:US
Mailing Address - Phone:617-999-8458
Mailing Address - Fax:
Practice Address - Street 1:875 MASSACHUSETTS AVE STE 83
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3071
Practice Address - Country:US
Practice Address - Phone:617-999-8458
Practice Address - Fax:919-782-7056
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0022461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2869744Medicare ID - Type Unspecified