Provider Demographics
NPI:1770648248
Name:DEVINE, SUSAN E (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:DEVINE
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:34 PARK ST
Mailing Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER OFFICE OF CARE MANAGEM
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-7417
Mailing Address - Fax:203-974-7413
Practice Address - Street 1:34 PARK ST
Practice Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-7417
Practice Address - Fax:203-974-7413
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CT003059364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist