Provider Demographics
NPI:1063083160
Name:WILLIAMS, SUE S (DR)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DR
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:S
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR
Mailing Address - Street 1:643 ROSEMOUNT LN
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-7916
Mailing Address - Country:US
Mailing Address - Phone:203-671-0937
Mailing Address - Fax:
Practice Address - Street 1:200 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2207
Practice Address - Country:US
Practice Address - Phone:475-242-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001544102L00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst