Provider Demographics
NPI:1467476192
Name:SUSCOVICH, DAVID JOSEPH (LMFT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:SUSCOVICH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 SOUTHFORD RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-3234
Mailing Address - Country:US
Mailing Address - Phone:203-758-2400
Mailing Address - Fax:203-758-2415
Practice Address - Street 1:984 SOUTHFORD RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-3234
Practice Address - Country:US
Practice Address - Phone:203-758-2400
Practice Address - Fax:203-758-2415
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000230106H00000X
CTCTOOO230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health