Provider Demographics
NPI:1528335445
Name:BAINBRIDGE, SUSAN MARIE (MS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HEMPSTEAD ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5638
Mailing Address - Country:US
Mailing Address - Phone:860-437-0517
Mailing Address - Fax:860-437-0518
Practice Address - Street 1:154 HEMPSTEAD ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5638
Practice Address - Country:US
Practice Address - Phone:860-437-0517
Practice Address - Fax:860-437-0518
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor