Provider Demographics
NPI:1134950363
Name:ENGELS, SUSANNE F (MA, MA)
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:F
Last Name:ENGELS
Suffix:
Gender:F
Credentials:MA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3605
Mailing Address - Country:US
Mailing Address - Phone:802-236-7405
Mailing Address - Fax:
Practice Address - Street 1:8 CONANT SQ
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-1018
Practice Address - Country:US
Practice Address - Phone:802-236-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000647103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist