Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 002008 | CT |
NPI | 1003469818 |
---|---|
Provider Name | Susan Robin Bass |
First Address | Columbia, CT 06237-1047 |
Second Address | Hebron, CT 06248-1514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2019 |
Last Update Date | 20/07/2019 |