Provider Demographics
NPI:1043358880
Name:DRAKE, SUSAN S (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271715
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06127-1715
Mailing Address - Country:US
Mailing Address - Phone:860-978-3368
Mailing Address - Fax:860-233-8110
Practice Address - Street 1:17 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1826
Practice Address - Country:US
Practice Address - Phone:860-978-3368
Practice Address - Fax:860-233-8110
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC38520OtherTRICARE
CT06111OtherOXFORD
KY22771OtherMHN
UT87726OtherUNITED BEHAVIORAL
MO01260OtherMAGELLAN
CT00060OtherANTHEM
TX60054OtherAETNA INSURANCE
MNSX071OtherCIGNA BEHAVIORAL