Individual
SUSANNE G TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
12 ROOSEVELT AVE, MYSTIC, CT 06355-2809
(860) 899-7711
Mailing address
12 ROOSEVELT AVE, MYSTIC, CT 06355-2809
(860) 889-7711
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
000618
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235942
—
CT
Enumeration date
11/29/2010
Last updated
12/10/2019
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