Provider Demographics
NPI:1942366034
Name:SHERIDAN, SUSAN N (MSW, BCDCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:N
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MSW, BCDCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LAFAYETTE PL
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5422
Mailing Address - Country:US
Mailing Address - Phone:203-661-2299
Mailing Address - Fax:
Practice Address - Street 1:28 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5422
Practice Address - Country:US
Practice Address - Phone:203-661-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0005971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140000597CT-1Medicare UPIN