MEDICARE: MS. SUSANNE M WEIL LCSW

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
1	104100000X	Social Worker	003095	CT

General Provider Information

NPI Number	:	1790846970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSANNE M WEIL LCSW

Provider Business Mailing Address
First Line	:	18 SEDGWICK VILLAGE LANE
Second Line	:
City	:	DARIEN
State	:	CT
Zip	:	06820-4601
Country	:	US
Telephone Number	:	203-656-9692
Fax Number	:	203-655-3813

Provider Business Practice Location Address
First Line	:	666 GLENBROOK RD
Second Line	:	#2C
City	:	STAMFORD
State	:	CT
Zip	:	06906-1439
Country	:	US
Telephone Number	:	203-327-4239
Fax Number	:	203-655-3813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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