Provider Demographics
NPI:1972634327
Name:KRINSKY, SUSAN G (EDD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:G
Last Name:KRINSKY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 EVANS ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-2117
Mailing Address - Country:US
Mailing Address - Phone:617-738-8676
Mailing Address - Fax:617-734-1318
Practice Address - Street 1:69 EVANS ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-2117
Practice Address - Country:US
Practice Address - Phone:617-738-8676
Practice Address - Fax:617-734-1318
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA574103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02062OtherBLUE CROSS BLUE SHIELD
W02062Medicare ID - Type Unspecified