Individual
CRISTINE E SUPPIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
98-100 YORK STREET, NEW HAVEN, CT 06460
(203) 785-6862
Mailing address
155 SYCAMORE ST, GLASTONBURY, CT 06033-4548
(860) 659-3553
(860) 659-0744
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008263
CT
1041C0700X
Clinical Social Worker
SW126730
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134375850
—
CT
Enumeration date
08/13/2008
Last updated
11/20/2018
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