Provider Demographics
NPI:1356375828
Name:FRECHETTE, SUSAN MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:FRECHETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 FRONT ST STE B
Mailing Address - Street 2:PO BOX 664
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1643
Mailing Address - Country:US
Mailing Address - Phone:860-315-9025
Mailing Address - Fax:866-212-7223
Practice Address - Street 1:96 FRONT ST STE B
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1643
Practice Address - Country:US
Practice Address - Phone:860-315-9025
Practice Address - Fax:866-212-7223
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008017733Medicaid