Provider Demographics
NPI:1730642935
Name:HENRY, SUSAN LIPMAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LIPMAN
Last Name:HENRY
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 1:35 NUTMEG LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3909
Mailing Address - Country:US
Mailing Address - Phone:203-258-8627
Mailing Address - Fax:203-259-3338
Practice Address - Street 1:35 NUTMEG LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-3909
Practice Address - Country:US
Practice Address - Phone:203-258-8627
Practice Address - Fax:203-259-3338
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical