Provider Demographics
NPI:1912069857
Name:BERGER, SUSAN R (EDD,)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:BERGER
Suffix:
Gender:
Credentials:EDD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SEWALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5240
Mailing Address - Country:US
Mailing Address - Phone:617-645-9672
Mailing Address - Fax:617-277-8638
Practice Address - Street 1:155 SEWALL AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5240
Practice Address - Country:US
Practice Address - Phone:617-645-9672
Practice Address - Fax:617-277-8638
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAHSP280103T00000X
MASW2030272104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
W02516Medicare ID - Type Unspecified