Suzanne Derosa, LPC
Individual provider Active NPI Professional Counselor · Woodbury, CT
NPI 1194031849 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1194031849
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 001350 (CT)
- Practice address
- 43 Sherman Hill Rd Ste 103
Woodbury, CT 06798-3651 - Phone
- (203) 509-8244
- NPI assigned
- Aug 19, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001350 | CT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthy Outlooks, LLC | Current | Accepting new patients |
Locations
900 Straits Tpke
Ste 205
Middlebury, CT 06762
Phone (203) 598-4492
43 Sherman Hill Rd
Ste 103
Woodbury, CT 06798
Phone (203) 509-8244
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 001350 | CT | Yes |
Addresses
Primary practice location
43 Sherman Hill Rd Ste 103
Woodbury, CT 06798-3651
Mailing address
42 Arvida Rd
Wolcott, CT 06716-2766
Phone (203) 509-8244
Other practice location 1
965 S Main St
Waterbury, CT 06706-1434
Phone (203) 596-9724 ext. 227
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194031849 | Medicaid | CT |
Other providers in Woodbury, CT
- Cornerstone Physical Therapy, LLC
- Ellen Cozan Tinios
- Eva Davidson
- Judith Davidson
- Raymond Michael Demers Jr.
- Gina L Donato
- Matthew Donovan
- Rachel Beth Dorfman
- Douglas Thompson, LLC
- Dr. Marina Zatman, MD PC
All providers in Woodbury, CT · Professional Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.