Provider Demographics
NPI:1396390423
Name:SUSAN S STARKIE LLC
Entity Type:Organization
Organization Name:SUSAN S STARKIE LLC
Other - Org Name:A MIND AT PEACE
Other - Org Type:Other Name
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STARKIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-292-8787
Mailing Address - Street 1:156 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5114
Mailing Address - Country:US
Mailing Address - Phone:203-292-8787
Mailing Address - Fax:
Practice Address - Street 1:156 ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5114
Practice Address - Country:US
Practice Address - Phone:203-292-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty