Provider Demographics
NPI:1447462262
Name:ORSILLO, SUSAN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:ORSILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 TEMPLE ST
Mailing Address - Street 2:PSYCHOLOGY DEPARTMENT SUFFOLK UNIVERSITY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4241
Mailing Address - Country:US
Mailing Address - Phone:781-942-8240
Mailing Address - Fax:
Practice Address - Street 1:13 BOWDOIN ST
Practice Address - Street 2:SUITE 1A/B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4246
Practice Address - Country:US
Practice Address - Phone:617-651-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical