Healthcare Provider Details

I. General information

NPI: 1326265612
Provider Name (Legal Business Name): SUSAN WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST STE 21
NEEDHAM MA
02494-3133
US

IV. Provider business mailing address

295 RIVER OAKS DR
HEATH OH
43056-8236
US

V. Phone/Fax

Practice location:
  • Phone: 781-363-3000
  • Fax:
Mailing address:
  • Phone: 781-363-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1100010
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6453
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6453
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.1100010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: