Healthcare Provider Details

I. General information

NPI: 1912298894
Provider Name (Legal Business Name): DEVON BICKFORD SUOZZI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 PINE ST
NEW CANAAN CT
06840-5425
US

IV. Provider business mailing address

58 PINE ST
NEW CANAAN CT
06840-5425
US

V. Phone/Fax

Practice location:
  • Phone: 203-801-8180
  • Fax:
Mailing address:
  • Phone: 203-801-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number58.007607
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: