Provider Demographics
NPI:1558016691
Name:VANBUREN, AMY SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUSAN
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LARKSPUR RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3903
Mailing Address - Country:US
Mailing Address - Phone:203-940-0379
Mailing Address - Fax:
Practice Address - Street 1:11 LARKSPUR RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-3903
Practice Address - Country:US
Practice Address - Phone:203-940-0379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical