1932250602 NPI number — MRS. SUZETTE ELIZABETH CARNAHAN LCSW

Table of content: MRS. SUZETTE ELIZABETH CARNAHAN LCSW (NPI 1932250602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932250602 NPI number — MRS. SUZETTE ELIZABETH CARNAHAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNAHAN
Provider First Name:
SUZETTE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932250602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 PINE ST
Provider Second Line Business Mailing Address:
STE 15
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14701-5313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-640-5316
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12809 W MAIN STREET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDOLPH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14772-9613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-640-5316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  73 063293 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)