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NPI Code Detail

MEDICARE: SUSAN MATLIN PICCONE MA, LPC

MEDICARE: SUSAN MATLIN PICCONE MA, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor3637CT

General Provider Information

NPI Number : 1235697285
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MATLIN PICCONE MA, LPC
Provider Business Mailing Address
First Line : 200 W CENTER ST STE C3
Second Line :
City : MANCHESTER
State : CT
Zip : 06040-4870
Country : US
Telephone Number : 844-428-8728
Fax Number : 860-432-1477
Provider Business Practice Location Address
First Line : 200 W CENTER ST STE C3
Second Line :
City : MANCHESTER
State : CT
Zip : 06040-4870
Country : US
Telephone Number : 844-428-8728
Fax Number : 860-432-1477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2019
Last Update Date : 03/08/2019

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