Provider Demographics
NPI:1447306154
Name:ABELSON, SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ABELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:ARBEIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1105 MASSACHUSETTS AVE APT 3B
Mailing Address - Street 2:SUITE # 3B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5207
Mailing Address - Country:US
Mailing Address - Phone:617-864-7823
Mailing Address - Fax:
Practice Address - Street 1:1105 MASSACHUSETTS AVE APT 3B
Practice Address - Street 2:SUITE # 3B
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5207
Practice Address - Country:US
Practice Address - Phone:617-864-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA767530OtherTUFTS
MAABW02140Medicare UPIN