Healthcare Provider Details

I. General information

NPI: 1740603992
Provider Name (Legal Business Name): SUSANNA MAUZY CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 VARNUM ST #3
ARLINGTON MA
02474-8712
US

IV. Provider business mailing address

31 VARNUM ST #3
ARLINGTON MA
02474-8712
US

V. Phone/Fax

Practice location:
  • Phone: 608-469-3725
  • Fax:
Mailing address:
  • Phone: 608-469-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: