1336471788 NPI number — MRS. SUZANNE TERESE BUTZKO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336471788 NPI number — MRS. SUZANNE TERESE BUTZKO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTZKO
Provider First Name:
SUZANNE
Provider Middle Name:
TERESE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTZKO
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
TERESE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPC, NCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336471788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 SASAPEQUAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06824-7242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-371-8264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 POST RD
Provider Second Line Business Practice Location Address:
206
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06824-6016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-371-8264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  000124 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)