MEDICARE: SUSAN G MCDUFFIE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	001035	CT

General Provider Information

NPI Number	:	1366535858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN G MCDUFFIE LMFT

Provider Business Mailing Address
First Line	:	2 HALEY RIDGE ROAD
Second Line	:
City	:	BEACON FALLS
State	:	CT
Zip	:	06403
Country	:	US
Telephone Number	:	203-729-9846
Fax Number	:	203-729-9846

Provider Business Practice Location Address
First Line	:	2 HALEY RIDGE ROAD
Second Line	:
City	:	BEACON FALLS
State	:	CT
Zip	:	06403
Country	:	US
Telephone Number	:	203-729-9846
Fax Number	:	203-729-9846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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