MEDICARE: DR. SUSAN M ORR PH.D.

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	103TC1900X	Counseling Psychologist	6741	MA

General Provider Information

NPI Number	:	1972768653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN M ORR PH.D.

Provider Business Mailing Address
First Line	:	26 CHESTNUT ST
Second Line	:
City	:	NORTH READING
State	:	MA
Zip	:	01864-2821
Country	:	US
Telephone Number	:	978-858-3776
Fax Number	:	978-858-3494

Provider Business Practice Location Address
First Line	:	352 PARK ST
Second Line	:	SUITE 208 WEST
City	:	NORTH READING
State	:	MA
Zip	:	01864-2164
Country	:	US
Telephone Number	:	781-771-2764
Fax Number	:

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

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	07/22/2008

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