Provider Demographics
NPI:1174778385
Name:MCGOWAN, SUSAN JEAN (LMFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 PUMPKIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3852
Mailing Address - Country:US
Mailing Address - Phone:203-400-7469
Mailing Address - Fax:203-365-4916
Practice Address - Street 1:483 PUMPKIN HILL RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3852
Practice Address - Country:US
Practice Address - Phone:203-400-7469
Practice Address - Fax:203-365-4916
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist