Healthcare Provider Details

I. General information

NPI: 1255477824
Provider Name (Legal Business Name): SUSAN M MEAGHER PH.D, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST # 1007 TUFTS MEDICAL CENTER
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST # 1007 TUFTS MEDICAL CENTER
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-0219
  • Fax: 617-636-4852
Mailing address:
  • Phone: 617-636-0219
  • Fax: 617-636-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9063
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: