Provider Demographics
NPI:1992735476
Name:SPILMAN, SUSAN (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SPILMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-8074
Mailing Address - Country:US
Mailing Address - Phone:508-430-8489
Mailing Address - Fax:
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:PSYCH CENTER - CAPE COD HOSPITAL
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5230
Practice Address - Country:US
Practice Address - Phone:508-862-5566
Practice Address - Fax:508-862-7387
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05243OtherBCBS
MA0511986Medicaid
MAW05243Medicare ID - Type Unspecified