Provider Demographics
NPI:1942410345
Name:WILLIAMS, SUSAN MACHANICH (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MACHANICH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EAST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5011
Mailing Address - Country:US
Mailing Address - Phone:203-445-1772
Mailing Address - Fax:
Practice Address - Street 1:108 EAST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5011
Practice Address - Country:US
Practice Address - Phone:203-445-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002151102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst