MEDICARE: DR. SUSANNE LUCILLE KING MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	51114	MA

General Provider Information

NPI Number	:	1578549739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANNE LUCILLE KING MD

Provider Business Mailing Address
First Line	:	51 CHURCH ST
Second Line	:
City	:	LENOX
State	:	MA
Zip	:	01240-2649
Country	:	US
Telephone Number	:	413-637-1531
Fax Number	:	413-637-4265

Provider Business Practice Location Address
First Line	:	51 CHURCH ST
Second Line	:
City	:	LENOX
State	:	MA
Zip	:	01240-2649
Country	:	US
Telephone Number	:	413-637-1531
Fax Number	:	413-637-4265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/08/2007

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