Healthcare Provider Details

I. General information

NPI: 1982658720
Provider Name (Legal Business Name): SUSAN S. FREEDMAN RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST SUITE 402
NEWTON MA
02462-1650
US

IV. Provider business mailing address

64 RIDGE AVE
NEWTON CENTRE MA
02459-2535
US

V. Phone/Fax

Practice location:
  • Phone: 617-965-5235
  • Fax: 617-527-0157
Mailing address:
  • Phone: 617-965-5235
  • Fax: 617-527-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number114131-PC
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: