Healthcare Provider Details

I. General information

NPI: 1285137000
Provider Name (Legal Business Name): SUSANNE SENIOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ROBBS HILL RD
LUNENBURG MA
01462-2167
US

IV. Provider business mailing address

81 MCCARTHY AVE
CHERRY VALLEY MA
01611-3252
US

V. Phone/Fax

Practice location:
  • Phone: 774-270-1766
  • Fax: 508-861-0206
Mailing address:
  • Phone: 774-633-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: