Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6255 | MA |
NPI | 1134288269 |
---|---|
Provider Name | Ms. Susan Christopherson |
First Address | Andover, MA 01810-3643 |
Second Address | Andover, MA 01810-3643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |