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General NPI Number Information
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NPI Number | 1790921286
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Entity Type | Individual
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Provider Name | SUSAN KRAUSS WHITBOURNE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 125 MILL ST
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City | FRAMINGHAM
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State | MA
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Zip | 01701
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Country | US
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Telephone | 413-237-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 32 EMILY LN
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City | AMHERST
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State | MA
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Zip | 01002-1581
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Country | US
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Telephone | 413-549-7670
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Fax |
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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 | 4701
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License Number State | MA
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