Provider Demographics
NPI:1679605893
Name:SORRENTINO, SUSAN A (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:266 ESSEX ST
Mailing Address - Street 2:UNIT #2
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:978-741-9011
Mailing Address - Fax:978-741-8610
Practice Address - Street 1:266 ESSEX ST
Practice Address - Street 2:UNIT #2
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01940
Practice Address - Country:US
Practice Address - Phone:978-741-9011
Practice Address - Fax:978-741-8610
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA062940OtherTUFTS
MAW05043OtherBLUE CROSS BLUE SHIELD MA