Provider Demographics
NPI:1952336893
Name:GREY, SUSAN E (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:GREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:GREY-HIGGISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 415933
Mailing Address - Street 2:HARTFORD HOSPITAL PROFESSIONAL SERVICES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5933
Mailing Address - Country:US
Mailing Address - Phone:860-545-7602
Mailing Address - Fax:
Practice Address - Street 1:200 RETREAT AVENUE
Practice Address - Street 2:HARTFORD HOSPITAL PSYCHIATRY DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3310
Practice Address - Country:US
Practice Address - Phone:860-545-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000977163WP0807X, 163WP0808X, 163WP0809X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7820698OtherAETNA PROVIDER NUMBER
CT004255677Medicaid
CT2037373OtherCIGNA PROVIDER NUMBER
CT400000977CT02OtherANTHEM BC/BS PROVIDER NUM
CTR33694OtherRN LICENSE
CTP3602617OtherOXFORD PROVIDER NUMBER
CT000977OtherAPRN LICENSE
CT24692OtherCONTROLLED SUBST. REGISTR
CTP3602617OtherOXFORD PROVIDER NUMBER
CTP02061Medicare UPIN