Provider Demographics
NPI:1326109471
Name:DUGAN, SUSAN JUDITH (CNS)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:JUDITH
Last Name:DUGAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MANSFIELD ROAD
Mailing Address - Street 2:ARJONA 4TH FLOOR
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-0001
Mailing Address - Country:US
Mailing Address - Phone:860-486-4705
Mailing Address - Fax:860-486-0792
Practice Address - Street 1:337 MANSFIELD ROAD
Practice Address - Street 2:ARJONA 4TH FLOOR
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-0001
Practice Address - Country:US
Practice Address - Phone:860-486-4705
Practice Address - Fax:860-486-0792
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR41382364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500000880Medicare ID - Type UnspecifiedFIRST COAST
P64667Medicare UPIN