Healthcare Provider Details

I. General information

NPI: 1023678869
Provider Name (Legal Business Name): SUZANNE MEYER-FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 SOUTH AVENUE
CHESHIRE CT
06410
US

IV. Provider business mailing address

673 SOUTH AVENUE
CHESHIRE CT
06410
US

V. Phone/Fax

Practice location:
  • Phone: 203-271-1430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118747
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003443
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: