Provider Demographics
NPI:1689887549
Name:WRIGHT, SUSAN (CAGS, LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5138
Mailing Address - Country:US
Mailing Address - Phone:401-944-1515
Mailing Address - Fax:401-944-1515
Practice Address - Street 1:989 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5138
Practice Address - Country:US
Practice Address - Phone:401-944-1515
Practice Address - Fax:401-944-1515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X
RIMHC00417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPC389Medicaid