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General NPI Number Information
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NPI Number | 1235697285
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Entity Type | Individual
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Provider Name | SUSAN MATLIN PICCONE MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 200 W CENTER ST STE C3
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City | MANCHESTER
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State | CT
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Zip | 06040-4870
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Country | US
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Telephone | 844-428-8728
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Fax | 860-432-1477
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Provider Business Mailing Address
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Address Line | 200 W CENTER ST STE C3
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City | MANCHESTER
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State | CT
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Zip | 06040-4870
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Country | US
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Telephone | 844-428-8728
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Fax | 860-432-1477
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3637
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License Number State | CT
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