Provider Demographics
NPI:1285890335
Name:TROTTER, SUSAN DEBRA (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEBRA
Last Name:TROTTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:TROTTER
Other - Last Name:NASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:27 HOLLIS ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8615
Mailing Address - Country:US
Mailing Address - Phone:508-661-2020
Mailing Address - Fax:
Practice Address - Street 1:27 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8615
Practice Address - Country:US
Practice Address - Phone:508-661-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical