Provider Demographics
NPI:1568646891
Name:TROMBLEY, SUSAN MUIR (LIC PSY MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MUIR
Last Name:TROMBLEY
Suffix:
Gender:F
Credentials:LIC PSY MA, LCMHC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:MUIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC PSY MA, LCMHC
Mailing Address - Street 1:31 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-1056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 FISHER POND RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6286
Practice Address - Country:US
Practice Address - Phone:802-524-6555
Practice Address - Fax:802-524-6562
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000073101YM0800X
VT047-0000465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health