Provider Demographics
NPI:1376206276
Name:BOOTH, SUSAN VICTORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VICTORIA
Last Name:BOOTH
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 1:55 RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1523
Mailing Address - Country:US
Mailing Address - Phone:203-689-5896
Mailing Address - Fax:
Practice Address - Street 1:55 RICHARD RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1523
Practice Address - Country:US
Practice Address - Phone:203-689-5896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical