Healthcare Provider Details

I. General information

NPI: 1639566672
Provider Name (Legal Business Name): SUSAN WESTFALL REARDON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN WESTFALL KLAUBERT LMHC

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BROOK LN
BERLIN MA
01503-1671
US

IV. Provider business mailing address

3 BROOK LN
BERLIN MA
01503-1671
US

V. Phone/Fax

Practice location:
  • Phone: 617-416-2172
  • Fax:
Mailing address:
  • Phone: 617-416-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5967
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: