Provider Demographics
NPI:1942535307
Name:STANTON, SUSAN TRACY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:TRACY
Last Name:STANTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3224
Mailing Address - Country:US
Mailing Address - Phone:201-560-6913
Mailing Address - Fax:
Practice Address - Street 1:15 DIVISION ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4606
Practice Address - Country:US
Practice Address - Phone:201-560-6913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist