Provider Demographics
NPI:1114047180
Name:SUGRUE, PAMELA G (MFT, LADC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:G
Last Name:SUGRUE
Suffix:
Gender:F
Credentials:MFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 NEW HAVEN AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6663
Mailing Address - Country:US
Mailing Address - Phone:203-882-0450
Mailing Address - Fax:203-882-0449
Practice Address - Street 1:354 NEW HAVEN AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-6663
Practice Address - Country:US
Practice Address - Phone:203-882-0450
Practice Address - Fax:203-882-0449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000540101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCIGNAOther2245298
CTCONNECTICAREOther62-32597
CTGOLDEN RULEOther62-32597
CTOXFORD HEALTHOtherP3182455
CTUNITED HEALTH CAREOther62-32597
CTANTHEM BLUE CROSSOther300000540CT02
CTPHCSOther93-62228
CTAETNAOther0007267777
CTHEALTHNETOther340399