Provider Demographics
NPI:1457323511
Name:RYNKIEWICZ, SUSAN A (LCSW LADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:RYNKIEWICZ
Suffix:
Gender:F
Credentials:LCSW LADC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:GRASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011
Mailing Address - Country:US
Mailing Address - Phone:860-585-3906
Mailing Address - Fax:860-585-3907
Practice Address - Street 1:440 D NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-314-2052
Practice Address - Fax:860-314-2054
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000710101YA0400X
CT0059161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical