Provider Demographics
NPI:1174817357
Name:SUSAN CONSOLI
Entity Type:Organization
Organization Name:SUSAN CONSOLI
Other - Org Name:CONSOLI & CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONSOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:860-575-8810
Mailing Address - Street 1:823 BOSTON POST RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:823 BOSTON POST RD
Practice Address - Street 2:SUITE 4
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2100
Practice Address - Country:US
Practice Address - Phone:860-575-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty