Provider Demographics
NPI:1174680599
Name:SUAREZ, MIGUEL G (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:G
Last Name:SUAREZ
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 1:31 WOODLAND ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4338
Mailing Address - Country:US
Mailing Address - Phone:860-724-1103
Mailing Address - Fax:
Practice Address - Street 1:90 FRANKLIN SQ
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2607
Practice Address - Country:US
Practice Address - Phone:860-225-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001484103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist