Susan Grace, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

002645 Issued in CT

Practice address

1153 Main St
Coventry, CT 06238-3115

Phone

(860) 341-2776

NPI assigned

Mar 22, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Natchaug Hospital, Inc.

  • Psychiatric Hospital
  • Mansfield Center, CT
  • NPI 1295811321
  NPD (past)

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545609600000",
    "number": "1679699284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 725",
            "city": "COVENTRY",
            "state": "CT",
            "postal_code": "062380725",
            "telephone_number": "860-989-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1153 MAIN ST",
            "city": "COVENTRY",
            "state": "CT",
            "postal_code": "062383115",
            "telephone_number": "860-341-2776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "189 Storrs Rd",
            "address_purpose": "LOCATION",
            "city": "Mansfield Center",
            "state": "CT",
            "postal_code": "062501683",
            "country_code": "US",
            "telephone_number": "860-456-1311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRACE",
        "first_name": "SUSAN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2018-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "002645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN",
            "identifier": "002645",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shanise Fleming, DC
• Emily Forsey, APRN
• Caitlin Gardner
• Ryanne Gatti, LMFT
• Mavis Elizabeth Godley, APRN
• Kari Hernandez, PHARMD
• Kevin Michael Hoffman, MS, LAT, ATC, OPE-C,
• Shirley Holloway, MSW
• Elena Fader Hurlburt, M.A. CCC-SLP
• Julie Lynn Ingenohl, M.S. MFT

• All providers in Coventry, CT
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2018; 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.