Individual
MS. SUSAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, CAC
Contact information
Practice address
1890 DIXWELL AVE, HAMDEN, CT 06514-3122
(860) 223-9291
(860) 223-3111
Mailing address
1890 DIXWELL AVE, HAMDEN, CT 06514-3122
(860) 223-9291
(860) 223-3111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000634
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000634
LADC
CT
01
—
3734
CAC
CT
Enumeration date
04/14/2008
Last updated
04/14/2008
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