=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265851943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUZANNE K. SUTCH, LPC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2014
-----------------------------------------------------
Last Update Date | 04/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MAIN STREET
-----------------------------------------------------
City | OLD SAYBROOK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-209-6866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 SUTTON RD
-----------------------------------------------------
City | ROCKY HILL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06067-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-209-6866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSE PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | SUZANNE SUTCH
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 860-209-6866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 002363
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------