Basic Information
| Provider Information | |||||||||
| NPI: | 1952336893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREY | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GREY-HIGGISON | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | E. | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 415933 | ||||||||
| Address2: | HARTFORD HOSPITAL PROFESSIONAL SERVICES | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022415933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605457602 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 RETREAT AVENUE | ||||||||
| Address2: | HARTFORD HOSPITAL PSYCHIATRY DEPT | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061063310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605457330 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | 000977 | CT | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 163WP0808X | 000977 | CT | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0809X | 000977 | CT | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 364SP0809X | 000977 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 7820698 | 01 | CT | AETNA PROVIDER NUMBER | OTHER | 004255677 | 05 | CT | MEDICAID | 2037373 | 01 | CT | CIGNA PROVIDER NUMBER | OTHER | 400000977CT02 | 01 | CT | ANTHEM BC/BS PROVIDER NUM | OTHER | R33694 | 01 | CT | RN LICENSE | OTHER | P3602617 | 01 | CT | OXFORD PROVIDER NUMBER | OTHER | 000977 | 01 | CT | APRN LICENSE | OTHER | 24692 | 01 | CT | CONTROLLED SUBST. REGISTR | OTHER |