Provider Demographics
NPI:1366477127
Name:KING, SUZANNE I (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:I
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3555
Mailing Address - Country:US
Mailing Address - Phone:203-876-0545
Mailing Address - Fax:203-876-0814
Practice Address - Street 1:204 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3555
Practice Address - Country:US
Practice Address - Phone:203-876-0545
Practice Address - Fax:203-876-0814
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT002831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061431528OtherTAX ID