Healthcare Provider Details

I. General information

NPI: 1467619908
Provider Name (Legal Business Name): SUSAN ELIZABETH HEGEDUS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PRINCETON ST SUITE 203
NORTH CHELMSFORD MA
01863-1558
US

IV. Provider business mailing address

73 PRINCETON ST
NORTH CHELMSFORD MA
01863-1558
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-6579
  • Fax: 978-256-1943
Mailing address:
  • Phone: 978-256-6579
  • Fax: 978-256-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: