MEDICARE: DEBRA SUTCLIFFE 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	1041C0700X	Clinical Social Worker	007293	CT
2	101YM0800X	Mental Health Counselor	007293	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871611426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA SUTCLIFFE LCSW

Provider Business Mailing Address
First Line	:	405 MAIN ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-4710
Country	:	US
Telephone Number	:	203-743-4412
Fax Number	:	120-373-8118

Provider Business Practice Location Address
First Line	:	405 MAIN ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-4710
Country	:	US
Telephone Number	:	203-743-4412
Fax Number	:	120-373-8118

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	11/18/2013

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