Provider Demographics
NPI:1972781615
Name:BERNSTEIN, SUSAN ELLEN (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELLEN
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1635
Mailing Address - Country:US
Mailing Address - Phone:617-775-0322
Mailing Address - Fax:
Practice Address - Street 1:339 WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1870
Practice Address - Country:US
Practice Address - Phone:617-775-0322
Practice Address - Fax:781-326-0355
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA112791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical