Provider Demographics
NPI:1760814545
Name:BETJEMANN, SUSAN (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BETJEMANN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN ST # 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:857-666-7337
Mailing Address - Fax:
Practice Address - Street 1:725 CONCORD AVE STE 4100
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1041
Practice Address - Country:US
Practice Address - Phone:617-864-7071
Practice Address - Fax:617-661-4682
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1155401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical