Provider Demographics
NPI:1851300958
Name:UBER, SUSAN REBECCA
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:REBECCA
Last Name:UBER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:UBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:135 CREEK ROW
Mailing Address - Street 2:
Mailing Address - City:EAST HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06423-1327
Mailing Address - Country:US
Mailing Address - Phone:860-873-8140
Mailing Address - Fax:860-343-9144
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3656
Practice Address - Country:US
Practice Address - Phone:860-347-4633
Practice Address - Fax:860-343-9144
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT037247OtherMHN
NYV-316SOtherEMPIRE BLUE CROSS
CTMIS014OtherOXFORD
CT060001083CT01OtherANTHEM BLUE CROSS
CT223412OtherMAGELLAN BEHAVIORAL HEALT
CT544802OtherAETNA
CT040799OtherCONNECTICARE