Provider Demographics
NPI:1093877300
Name:CARON, SUSIE ELIZABETH (MA)
Entity Type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:ELIZABETH
Last Name:CARON
Suffix:
Gender:F
Credentials:MA
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 275
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-0275
Mailing Address - Country:US
Mailing Address - Phone:802-849-2777
Mailing Address - Fax:
Practice Address - Street 1:325 SWAMP RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VT
Practice Address - Zip Code:05454-9777
Practice Address - Country:US
Practice Address - Phone:802-849-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000717103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011337Medicaid