Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 7374 | MA |
N | 103T00000X | Psychologist | 7374 | MA |
N | 102L00000X | Psychologist | 7374 | MA |
N | 103T00000X | Psychologist | 7374 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 7374 | MA |
N | 103G00000X | Clinical Psychologist | 7374 | MA |
N | 103TC0700X | Clinical Psychologist | 7374 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 7374 | MA |
Y | 103TP0814X | Psychoanalysis | 7374 | MA |
NPI | 1457343980 |
---|---|
Provider Name | Dr. Susan D Siroty |
First Address | West Newton, MA 02465-2185 |
Second Address | West Newton, MA 02465-2185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 01/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7374 | PSYCHOLOGIST (01) | MA |