Provider Demographics
NPI:1235639444
Name:CHETRAM, SURSATIE DEVI (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SURSATIE
Middle Name:DEVI
Last Name:CHETRAM
Suffix:
Gender:F
Credentials:PHD, LPC
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 211
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-0211
Mailing Address - Country:US
Mailing Address - Phone:203-500-6152
Mailing Address - Fax:860-736-2222
Practice Address - Street 1:100 TALCOTT AVE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3142
Practice Address - Country:US
Practice Address - Phone:203-500-6152
Practice Address - Fax:860-736-2222
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.003262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty