Provider Demographics
NPI:1790846970
Name:WEIL, SUSANNE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:M
Last Name:WEIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18 SEDGWICK VILLAGE LANE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4601
Mailing Address - Country:US
Mailing Address - Phone:203-656-9692
Mailing Address - Fax:203-655-3813
Practice Address - Street 1:666 GLENBROOK RD
Practice Address - Street 2:#2C
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1439
Practice Address - Country:US
Practice Address - Phone:203-327-4239
Practice Address - Fax:203-655-3813
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003095104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker