Provider Demographics
NPI:1528262417
Name:GUERRUCCI, SUZANNE (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GUERRUCCI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WAINWRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3248
Mailing Address - Country:US
Mailing Address - Phone:203-864-1220
Mailing Address - Fax:
Practice Address - Street 1:163 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2112
Practice Address - Country:US
Practice Address - Phone:203-864-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0035721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800001931Medicare ID - Type Unspecified