Provider Demographics
NPI:1285294108
Name:BRUSKY, SUSAN (LICSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BRUSKY
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 1:101 GREAT RD STE 374
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2715
Mailing Address - Country:US
Mailing Address - Phone:508-474-9250
Mailing Address - Fax:
Practice Address - Street 1:101 GREAT RD STE 374
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2715
Practice Address - Country:US
Practice Address - Phone:508-474-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA2248751041C0700X
MA1241081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical