Provider Demographics
NPI:1861667776
Name:GUBILEE, SUSAN MARY (MS, MSW)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MARY
Last Name:GUBILEE
Suffix:
Gender:F
Credentials:MS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1433
Mailing Address - Country:US
Mailing Address - Phone:860-342-4079
Mailing Address - Fax:
Practice Address - Street 1:11 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1433
Practice Address - Country:US
Practice Address - Phone:860-342-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical