Provider Demographics
NPI:1437214079
Name:DELEON, SUSAN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:DELEON
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 1:25 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5802
Mailing Address - Country:US
Mailing Address - Phone:203-929-1117
Mailing Address - Fax:203-925-9645
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5802
Practice Address - Country:US
Practice Address - Phone:203-929-1117
Practice Address - Fax:203-925-9645
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist