1639711690 NPI number — MRS. CRISTINA LYN SUITCA MSW, LISW

Table of content: MRS. CRISTINA LYN SUITCA MSW, LISW (NPI 1639711690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639711690 NPI number — MRS. CRISTINA LYN SUITCA MSW, LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUITCA
Provider First Name:
CRISTINA
Provider Middle Name:
LYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMPU
Provider Other First Name:
CRISTINA
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639711690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44601-0688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-680-9020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2011 GLAMORGAN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44601-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-614-2777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2019

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:  I.1901842 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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