Provider Demographics
NPI:1407137326
Name:GOOD, SUSAN POSSIDENTE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:POSSIDENTE
Last Name:GOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HADDAM QUARTER RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-1708
Mailing Address - Country:US
Mailing Address - Phone:860-349-2299
Mailing Address - Fax:
Practice Address - Street 1:1 CHURCH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3330
Practice Address - Country:US
Practice Address - Phone:203-764-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health