Healthcare Provider Details

I. General information

NPI: 1912098427
Provider Name (Legal Business Name): SUSAN HUPFER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ACTON ROAD SUITE 24
CHELMSFORD MA
01824
US

IV. Provider business mailing address

1 DAVID HENRY GARDNER LN
SOUTHBORO MA
01772
US

V. Phone/Fax

Practice location:
  • Phone: 978-742-9799
  • Fax: 508-486-0082
Mailing address:
  • Phone: 978-742-9799
  • Fax: 508-486-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1020915
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: