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General NPI Number Information
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NPI Number | 1639328974
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Entity Type | Individual
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Provider Name | SUSAN A. BORITZ M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 25 CHURCH HILL RD STE 201B
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City | NEWTOWN
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State | CT
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Zip | 06470-1646
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Country | US
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Telephone | 203-917-8585
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Fax | 203-826-2211
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Provider Business Mailing Address
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Address Line | 401A HERITAGE VLG
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City | SOUTHBURY
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State | CT
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Zip | 06488-5708
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Country | US
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Telephone | 203-917-8585
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Fax | 203-826-2211
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000910
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001240
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001240
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License Number State | CT
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