Provider Demographics
NPI:1548319460
Name:SURENA-MATTSON, DANA MARIE (MA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:SURENA-MATTSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:11 FOREST ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4745
Mailing Address - Country:US
Mailing Address - Phone:203-966-7225
Mailing Address - Fax:203-920-1402
Practice Address - Street 1:11 FOREST ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4745
Practice Address - Country:US
Practice Address - Phone:203-966-7225
Practice Address - Fax:203-920-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist