Healthcare Provider Details

I. General information

NPI: 1629252333
Provider Name (Legal Business Name): SUSAN CRAPENTER BRUFFEE M ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LYMAN TER
SOUTH HADLEY MA
01075-2623
US

IV. Provider business mailing address

310 BATCHELOR ST
GRANBY MA
01033-9740
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-7140
  • Fax:
Mailing address:
  • Phone: 413-467-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: