Provider Demographics
NPI:1700982022
Name:LEWIS, SUSAN VAUGHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VAUGHAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:LEWIS
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:950 CAMPBELL AVE
Mailing Address - Street 2:116A
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2770
Mailing Address - Country:US
Mailing Address - Phone:203-932-5711
Mailing Address - Fax:203-937-4962
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:116A
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-937-4962
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT232072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry