1932280880 NPI number — SUZANNE ELLEN STEWART PALMISANO LPCC LICDC

Table of content: SUZANNE ELLEN STEWART PALMISANO LPCC LICDC (NPI 1932280880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932280880 NPI number — SUZANNE ELLEN STEWART PALMISANO LPCC LICDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART PALMISANO
Provider First Name:
SUZANNE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC LICDC
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:
1932280880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 ROCKSIDE RD
Provider Second Line Business Mailing Address:
SUITE 390
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-2368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-524-2776
Provider Business Mailing Address Fax Number:
216-524-2778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 ROCKSIDE RD
Provider Second Line Business Practice Location Address:
SUITE 390
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-2368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-524-2776
Provider Business Practice Location Address Fax Number:
216-524-2778
Provider Enumeration Date:
10/18/2006

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: 101YA0400X , with the licence number:  841098 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E2156 , 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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