Provider Demographics
NPI:1346065265
Name:WALDRON, SUZANNE (MS/CAGS, LEP)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MS/CAGS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 BOSTON ST APT 5
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1970
Mailing Address - Country:US
Mailing Address - Phone:978-884-2219
Mailing Address - Fax:
Practice Address - Street 1:663 BOSTON ST APT 5
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-1970
Practice Address - Country:US
Practice Address - Phone:978-884-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA330461103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool