Healthcare Provider Details

I. General information

NPI: 1063083160
Provider Name (Legal Business Name): SUE S WILLIAMS DR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUE S WILLIAMS DR

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STATE ST
NORTH HAVEN CT
06473-2207
US

IV. Provider business mailing address

643 ROSEMOUNT LN
WEST HAVEN CT
06516-7916
US

V. Phone/Fax

Practice location:
  • Phone: 475-242-5192
  • Fax:
Mailing address:
  • Phone: 203-671-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number001544
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001544
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: