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Individual

SUSAN FORMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
270 AMITY RD, SUITE 130, WOODBRIDGE, CT 06525
(203) 397-0064
(203) 397-3537
Mailing address
270 AMITY RD, SUITE 130, WOODBRIDGE, CT 06525
(203) 397-0064
(203) 397-3537

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
001232
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11585299
CAQ0H
Enumeration date
08/16/2006
Last updated
07/08/2007
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