Provider Demographics
NPI:1043074800
Name:LOOMIS, SUSAN P (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 NEWFIELD AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3300
Mailing Address - Country:US
Mailing Address - Phone:804-363-0621
Mailing Address - Fax:
Practice Address - Street 1:566 NEWFIELD AVE APT 9
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3300
Practice Address - Country:US
Practice Address - Phone:804-363-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6904104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker