Provider Demographics
NPI:1396616082
Name:HENRIQUEZ-WHITTED, SUZAN (MA)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:HENRIQUEZ-WHITTED
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 HALLOCK AVE # 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2629
Mailing Address - Country:US
Mailing Address - Phone:475-365-8157
Mailing Address - Fax:
Practice Address - Street 1:278 HALLOCK AVE # 2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-2629
Practice Address - Country:US
Practice Address - Phone:475-365-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health