Healthcare Provider Details

I. General information

NPI: 1750521589
Provider Name (Legal Business Name): SUSAN M PFEIL LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 EAST AVE
NORWALK CT
06851-4905
US

IV. Provider business mailing address

275A PARK ST
NEW CANAAN CT
06840-5739
US

V. Phone/Fax

Practice location:
  • Phone: 203-853-2798
  • Fax:
Mailing address:
  • Phone: 203-966-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000253
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001488
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: