Provider Demographics
NPI:1811191281
Name:MONTESANO-MCLEAN, SUZANNE (MS, CRC,LP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:MONTESANO-MCLEAN
Suffix:
Gender:F
Credentials:MS, CRC,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CHIOUS DR
Mailing Address - Street 2:
Mailing Address - City:GRISWOLD
Mailing Address - State:CT
Mailing Address - Zip Code:06351-1431
Mailing Address - Country:US
Mailing Address - Phone:860-456-0151
Mailing Address - Fax:860-376-6617
Practice Address - Street 1:1 RICHMOND LN
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-3825
Practice Address - Country:US
Practice Address - Phone:860-456-0151
Practice Address - Fax:860-376-9644
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000539101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor