Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 9530 | MA |
Y | 103TC0700X | Clinical Psychologist | 9530 | MA |
NPI | 1003170580 |
---|---|
Provider Name | Dr. Susan Elisabet Enck |
First Address | Marlborough, MA 01752-3577 |
Second Address | Marlborough, MA 01752-3577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 28/06/2012 |