Provider Demographics
NPI:1154476778
Name:CIARAMELLA, SUZANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:CIARAMELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06280-1219
Mailing Address - Country:US
Mailing Address - Phone:860-916-4253
Mailing Address - Fax:
Practice Address - Street 1:6 STORRS RD
Practice Address - Street 2:SUITE #3
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250
Practice Address - Country:US
Practice Address - Phone:860-423-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002467CT01OtherANTHEM BCBS
CT345897OtherMHN