Basic Information
| Provider Information | |||||||||
| NPI: | 1265518641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CURTISS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 MYSTIC AVE STE 6 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021554632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813961199 | ||||||||
| FaxNumber: | 7813961439 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 NEW STATE HWY STE 6 | ||||||||
| Address2: | |||||||||
| City: | RAYNHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027675461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088806868 | ||||||||
| FaxNumber: | 5088806848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2006 | ||||||||
| LastUpdateDate: | 06/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 001184 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.