Provider Demographics
NPI:1457671653
Name:SUSSMAN, JAQUELINE LAPA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:LAPA
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SASQUA TRL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-1025
Mailing Address - Country:US
Mailing Address - Phone:203-544-8409
Mailing Address - Fax:203-544-7168
Practice Address - Street 1:11 SASQUA TRL
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:CT
Practice Address - Zip Code:06883-1025
Practice Address - Country:US
Practice Address - Phone:203-544-8409
Practice Address - Fax:203-544-7168
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health