Provider Demographics
NPI:1417427527
Name:BOAFO-ARTHUR, SUSAN
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:BOAFO-ARTHUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SHELDON RD UNIT 2481
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06045-7100
Mailing Address - Country:US
Mailing Address - Phone:860-281-7847
Mailing Address - Fax:
Practice Address - Street 1:111 SHELDON RD UNIT 2481
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06045
Practice Address - Country:US
Practice Address - Phone:860-281-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2022-08-29
Deactivation Date:2020-12-06
Deactivation Code:
Reactivation Date:2021-02-09
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
PAPC009365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherN/A