Provider Demographics
NPI:1962602227
Name:WRIGHT, SUSAN JANE (MS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANE
Last Name:WRIGHT
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 1:29 LANCE AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03052-1082
Mailing Address - Country:US
Mailing Address - Phone:603-657-4370
Mailing Address - Fax:603-424-1209
Practice Address - Street 1:1 COMMONS DR # F
Practice Address - Street 2:SUITE 34
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3441
Practice Address - Country:US
Practice Address - Phone:603-657-4370
Practice Address - Fax:603-424-1209
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NH796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor