Provider Demographics
NPI:1174073761
Name:CHRISTOFERSON, SUZANNE M (LPC, ATR-BC)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:CHRISTOFERSON
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:SCALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, ATR-BC
Mailing Address - Street 1:199 WAITE ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2530
Mailing Address - Country:US
Mailing Address - Phone:413-717-0250
Mailing Address - Fax:
Practice Address - Street 1:88 OLD BROADWAY W
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1631
Practice Address - Country:US
Practice Address - Phone:413-717-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3019101YP2500X
CT003019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional