Provider Demographics
NPI:1255767398
Name:SUTCH, SUZANNE (LPC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SUTCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2109
Mailing Address - Country:US
Mailing Address - Phone:860-521-8035
Mailing Address - Fax:860-521-8036
Practice Address - Street 1:1022 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2105
Practice Address - Country:US
Practice Address - Phone:860-313-1119
Practice Address - Fax:860-313-1449
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT261QM0855XMedicaid
CT008001149Medicare Oscar/Certification