Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4043 | MA |
NPI | 1124119292 |
---|---|
Provider Name | Susan Mcquiston |
First Address | Amherst, MA 01002-2362 |
Second Address | Amherst, MA 01002-2362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 13/02/2013 |