Provider Demographics
NPI:1114405792
Name:PERSAD, SUMATEE
Entity Type:Individual
Prefix:
First Name:SUMATEE
Middle Name:
Last Name:PERSAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FRONT ST APT 312
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4850
Mailing Address - Country:US
Mailing Address - Phone:917-843-9981
Mailing Address - Fax:
Practice Address - Street 1:360 MERRIMACK ST STE 9
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1764
Practice Address - Country:US
Practice Address - Phone:917-843-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health