DR. SUSAN DICKEY BURLESON (NPI# 1912101692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912101692 |
| Entity Type | Individual |
| Full Name | DR. SUSAN DICKEY BURLESON |
| Other Name | DR. SUSAN DICKEY BURLESON |
| Credential | PHD |
| Practice Address |
639 Prospect Ave Hartford CT 06105-4276 |
| Mailing Address |
66 Lemay St West Hartford CT 06107-3025 |
| Practice Telephone | 8609300021 |
| Mailing Telephone | 2019703644 |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2012-03-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
003157 | CT | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
4961 | NY | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
2083 | NJ | Behavioral Health & Social Service Providers |
| Street Address |
639 PROSPECT AVE |
| City | HARTFORD |
| State | CT |
| Zip Code | 06105-4276 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609946581 | Deborah Ann Doherty | Psychologist | 639 Prospect Ave, Hartford, CT 06105-4276 | 2006-11-08 |
| 1881894830 | Rose Marie Deroche | Social Worker | 639 Prospect Ave, Hartford, CT 06105-4276 | 2007-07-18 |
| 1306996160 | Jay M Cudrin | Psychologist | 639 Prospect Ave, Hartford, CT 06105-4276 | 2007-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275155939 | Pruthwy R Addanki | Student in an Organized Health Care Education/Training Program | Saint Francis Clinic, 1000 Asylum Avenue, Suite 1004, Hartford, CT 06105 | 2020-05-15 |
| 1700447802 | Samuel Flynn | Student in an Organized Health Care Education/Training Program | 1000 Asylum Avenue, Suite 3200, Hartford, CT 06105 | 2019-06-28 |
| 1730743568 | Turab J Mohammed | Student in an Organized Health Care Education/Training Program | Saint Francis Hospital Clinic, 1000 Asylum Avenue, Suite 1004, Hartford, CT 06105 | 2019-04-26 |
| 1164900387 | Breanne Ferrara | Social Worker | 43 Wooland St, Hartford, CT 06105 | 2018-07-31 |
| 1154814069 | Signature Smiles of Hartford LLC | Dentist | 550 Farmington Avenue, Suite B, Hartford, CT 06105 | 2018-06-14 |
| 1356839062 | Jaimy Villavicencio | Student in an Organized Health Care Education/Training Program | 100 Asylum Avenue, Suite 1004, Hartford, CT 06105 | 2018-04-27 |
| 1750885679 | Brittany Bird | Student in an Organized Health Care Education/Training Program | 839-841 Asylum Avenue, Hartford, CT 06105 | 2018-03-23 |
| 1972032241 | Ashley Nicole Mills | Student in an Organized Health Care Education/Training Program | 896 Asylum Ave, 3rd Floor, Hartford, CT 06105 | 2017-06-08 |
| 1528506847 | Samuel Agyei | Social Worker | 291 Collins St, Hartford, CT 06105 | 2017-02-07 |
| 1841735818 | Katie Strahowski | Nurse Practitioner | 85 Gillett Street, Clean Slate, Hartford, CT 06105 | 2016-12-30 |
| Find all providers in zip 06105 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366065963 | Leah Elizabeth Morgan | Psychologist | 56 Arbor St Ste 100-a, Hartford, CT 06106-1222 | 2020-05-19 |
| 1306318670 | Integrative Psychological Center LLC | Psychologist | 44 Capitol Ave Ste 402, Hartford, CT 06106-1764 | 2018-12-26 |
| 1326553983 | Marissa Sicley-rogers | Psychologist | 200 Retreat Ave Bldg 5th, Hartford, CT 06106-3309 | 2017-12-05 |
| 1508394834 | Ct Psychological Consulting Services, LLC | Psychologist | 210 Wethersfield Ave Fl 2, Hartford, CT 06114-1113 | 2017-05-31 |
| 1891049003 | Randall Kent Wallace | Psychologist | 36 Russ St, Hartford, CT 06106-1520 | 2012-11-09 |
| 1326399213 | Kathryne Stuart Marinchak | Psychologist | 135 Allen Pl, Hartford, CT 06106-3103 | 2012-10-02 |
| 1255681813 | Silvia Corbera Lopez | Psychologist | 200 Retreat Avnue, Hartford Hospital Psychiatry Dept, Hartford, CT 06106-3310 | 2012-09-11 |
| 1801165469 | Angelica Valentin-colon | Psychologist | 151 New Park Avenue, Suite 117, Hartford, CT 06106-2152 | 2011-12-27 |
| 1184776163 | Stephen Michael Humphrey | Psychologist | 602 New Britain Ave, Hartford, CT 06106-4033 | 2007-01-18 |
| 1275609711 | Sean Timothy Hart | Psychologist | 864 Wethersfield Avenue First Floor, Hartford Center for Psychotherapy, Hartford, CT 06114 | 2006-11-27 |
| Find all providers in HARTFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.