Provider Demographics
NPI:1760570980
Name:MARY BETH SUTTER, LCSW, LLC
Entity Type:Organization
Organization Name:MARY BETH SUTTER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-397-7973
Mailing Address - Street 1:1 BRADLEY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2285
Mailing Address - Country:US
Mailing Address - Phone:203-397-7973
Mailing Address - Fax:
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2285
Practice Address - Country:US
Practice Address - Phone:203-397-7973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty