Provider Demographics
NPI:1205141397
Name:MOSS, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HOBART ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2932
Mailing Address - Country:US
Mailing Address - Phone:203-389-1551
Mailing Address - Fax:203-553-7833
Practice Address - Street 1:133 HOBART ST
Practice Address - Street 2:2ND FLR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2932
Practice Address - Country:US
Practice Address - Phone:203-389-1551
Practice Address - Fax:203-553-7833
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor