Healthcare Provider Details

I. General information

NPI: 1619063229
Provider Name (Legal Business Name): SUSAN ELIZABETH SCHENBERG TEMPLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 GREAT PLAIN AVE
NEEDHAM MA
02492
US

IV. Provider business mailing address

992 GREAT PLAIN AVE
NEEDHAM MA
02492
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-8049
  • Fax: 781-449-3134
Mailing address:
  • Phone: 781-449-8049
  • Fax: 781-449-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101893
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001893
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: