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General NPI Number Information
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NPI Number | 1194125849
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Entity Type | Individual
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Provider Name | SUSAN K. MONK LPC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2014
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Last Update Date | 08/31/2014
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Provider Practice Location Address
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Address Line | 761 PONTIAC LN
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City | STRATFORD
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State | CT
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Zip | 06614-8330
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Country | US
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Telephone | 203-212-3758
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Fax | 203-212-3758
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Provider Business Mailing Address
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Address Line | 761 PONTIAC LN
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City | STRATFORD
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State | CT
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Zip | 06614-8330
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Country | US
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Telephone | 203-212-3758
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Fax | 203-212-3758
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000567
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License Number State | CT
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