Provider Demographics
NPI:1194125849
Name:MONK, SUSAN K (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:MONK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 PONTIAC LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-8330
Mailing Address - Country:US
Mailing Address - Phone:203-212-3758
Mailing Address - Fax:203-212-3758
Practice Address - Street 1:761 PONTIAC LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-8330
Practice Address - Country:US
Practice Address - Phone:203-212-3758
Practice Address - Fax:203-212-3758
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health