Provider Demographics
NPI:1073221669
Name:SUAREZ, JUAN MANUEL (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 MANOR AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5932
Mailing Address - Country:US
Mailing Address - Phone:347-628-9862
Mailing Address - Fax:
Practice Address - Street 1:1036 MANOR AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5932
Practice Address - Country:US
Practice Address - Phone:347-628-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00675900103TC0700X
NY022396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical