Provider Demographics
NPI:1871520304
Name:GOSTANIAN, SUE ELLEN (LPC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:GOSTANIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLD NEW MILFORD RD
Mailing Address - Street 2:2F
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2426
Mailing Address - Country:US
Mailing Address - Phone:203-775-2583
Mailing Address - Fax:203-775-2863
Practice Address - Street 1:2 OLD NEW MILFORD RD
Practice Address - Street 2:2F
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-775-2583
Practice Address - Fax:203-775-2863
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0004332774OtherAETNA HEALTH CARE
CT1065880000OtherMAGELLAN HEALTH CARE
CTP1093372OtherOXFORD HEALTH CARE
CT018638OtherMHN
CT240000111CT01OtherABH
CT9374982OtherPHCS
CT0102904OtherGHI
CO132249OtherVALUE OPTIONS
CT9374982OtherPHCS