Provider Demographics
NPI:1760832299
Name:ANDREYEV, SUZANNE C
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:C
Last Name:ANDREYEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 THORN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2960
Mailing Address - Country:US
Mailing Address - Phone:860-965-0444
Mailing Address - Fax:
Practice Address - Street 1:106 THORN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2960
Practice Address - Country:US
Practice Address - Phone:860-965-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional