Susan E Dieterich PHD LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

002826 Issued in CT

Legal business name

SUSAN E DIETERICH PHD LLC

Practice address

64 Post Rd W
Westport, CT 06880-4208

Phone

(203) 635-2622

NPI assigned

Oct 25, 2016

Last updated

Oct 25, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan DieterichNPI 1184642811

Title

Psychologist

Phone

(203) 635-2622

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan E Dieterich, PH.D.

  • Psychologist
  • Westport, CT
  • NPI 1184642811
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1598217614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 POST RD W",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068804208",
            "telephone_number": "203-635-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 POST RD W",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068804208",
            "telephone_number": "203-635-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN E DIETERICH PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "DIETERICH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "203-635-2622",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CT",
            "license": "002826",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CT",
            "license": "002826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Howard David Stupak, MD
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• Katherine Michele Sullivan, MSW, LCSW
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• Carol Swenson, PH.D.
• Sarah C Swenson, NP
• Maryam Syed, DO

• Adolescent and Children Mental Health Clinic/Center in Westport, CT
• Providers in Westport, CT by specialty
• Adolescent and Children Mental Health Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.