Provider Demographics
NPI:1972867695
Name:BOORIN, SUSAN J (PHD, APRN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:BOORIN
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SILVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1115
Mailing Address - Country:US
Mailing Address - Phone:203-521-1927
Mailing Address - Fax:
Practice Address - Street 1:120 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4725
Practice Address - Country:US
Practice Address - Phone:203-693-2636
Practice Address - Fax:203-283-5877
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003777363LP0808X
NYF401504363LP0808X
CT3777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty