Provider Demographics
NPI:1336471788
Name:BUTZKO, SUZANNE TERESE
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:TERESE
Last Name:BUTZKO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:TERESE
Other - Last Name:BUTZKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, NCC
Mailing Address - Street 1:370 SASAPEQUAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-7242
Mailing Address - Country:US
Mailing Address - Phone:203-371-8264
Mailing Address - Fax:
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:206
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-371-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional