1912071499 NPI number — MR. MICHAEL SUNSERI LCSW

Table of content: MR. MICHAEL SUNSERI LCSW (NPI 1912071499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912071499 NPI number — MR. MICHAEL SUNSERI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNSERI
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1912071499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10819 RIDGELY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-802-5407
Provider Business Mailing Address Fax Number:
225-952-9214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4521 JAMESTOWN AVE
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-952-9210
Provider Business Practice Location Address Fax Number:
225-952-9214
Provider Enumeration Date:
11/17/2006

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:  3354 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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