Provider Demographics
NPI:1073532917
Name:SUTTON, ROBERT G (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:SUTTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RACE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3110
Mailing Address - Country:US
Mailing Address - Phone:860-521-4788
Mailing Address - Fax:
Practice Address - Street 1:55 NYE RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1281
Practice Address - Country:US
Practice Address - Phone:860-521-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5720095OtherAETNA
CTP622828OtherOXFORD HEALTH PLANS
CT060001165CT03OtherANTHEM BLUE CROSS BLUE SH