Provider Demographics
NPI:1023592607
Name:BROSTRUP-JENSEN, SUSAN ASTRID (PHD, MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ASTRID
Last Name:BROSTRUP-JENSEN
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-2405
Mailing Address - Country:US
Mailing Address - Phone:508-341-8222
Mailing Address - Fax:
Practice Address - Street 1:355 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-2405
Practice Address - Country:US
Practice Address - Phone:508-341-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027335104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker