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General NPI Number Information
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NPI Number | 1346200193
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Entity Type | Individual
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Provider Name | SUSAN M BREFACH ED.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4 MILITIA DR SUITE 23
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City | LEXINGTON
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State | MA
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Zip | 02421-4737
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Country | US
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Telephone | 781-860-7211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 230
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City | LEXINGTON
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State | MA
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Zip | 02420-0003
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Country | US
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Telephone | 781-860-7211
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Fax | 617-249-0446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4530
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License Number State | MA
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