Provider Demographics
NPI:1093922379
Name:CARROLL, SUZANNE DELP (EDD,LMFT)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:DELP
Last Name:CARROLL
Suffix:
Gender:F
Credentials:EDD,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MADISON SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2419
Mailing Address - Country:US
Mailing Address - Phone:203-392-6412
Mailing Address - Fax:
Practice Address - Street 1:55 MADISON SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2419
Practice Address - Country:US
Practice Address - Phone:203-392-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000820106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist