Provider Demographics
NPI:1962544270
Name:SUSAN H. BECKER, APRN, BC, PC
Entity type:Organization
Organization Name:SUSAN H. BECKER, APRN, BC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:781-255-0303
Mailing Address - Street 1:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1782
Mailing Address - Country:US
Mailing Address - Phone:781-255-0303
Mailing Address - Fax:781-255-0356
Practice Address - Street 1:20 VERNON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2184
Practice Address - Country:US
Practice Address - Phone:781-255-0303
Practice Address - Fax:781-255-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119469163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858424Medicaid
MAS94566Medicare UPIN
MA1858424Medicaid