Provider Demographics
NPI:1578640082
Name:VAN VECHTEN, SUZANNE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:A
Last Name:VAN VECHTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 OLD BELDEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4217
Mailing Address - Country:US
Mailing Address - Phone:203-762-0677
Mailing Address - Fax:
Practice Address - Street 1:108 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5011
Practice Address - Country:US
Practice Address - Phone:203-858-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health