Healthcare Provider Details

I. General information

NPI: 1174430029
Provider Name (Legal Business Name): SUSAN P FENDRICK MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LINCOLN ST
NEWTON HIGHLANDS MA
02461-1561
US

IV. Provider business mailing address

530 COMMONWEALTH AVE
NEWTON CENTER MA
02459-1634
US

V. Phone/Fax

Practice location:
  • Phone: 617-771-5253
  • Fax:
Mailing address:
  • Phone: 617-771-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: