Provider Demographics
NPI:1174889109
Name:STAHR, SUSANNAH JANE FORTE (MS, MFT)
Entity type:Individual
Prefix:MS
First Name:SUSANNAH
Middle Name:JANE FORTE
Last Name:STAHR
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:SUSANNAH
Other - Middle Name:JANE
Other - Last Name:FORTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:255 HEMPSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6204
Mailing Address - Country:US
Mailing Address - Phone:860-443-2896
Mailing Address - Fax:860-442-5909
Practice Address - Street 1:591 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4571
Practice Address - Country:US
Practice Address - Phone:860-449-8217
Practice Address - Fax:860-449-8323
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health