Healthcare Provider Details

I. General information

NPI: 1154005528
Provider Name (Legal Business Name): JULIE A SUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SILVER ST
MIDDLETOWN CT
06457-3946
US

IV. Provider business mailing address

1250 SILVER ST
MIDDLETOWN CT
06457-3946
US

V. Phone/Fax

Practice location:
  • Phone: 860-346-0300
  • Fax:
Mailing address:
  • Phone: 860-346-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8947
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: