Provider Demographics
NPI:1114702289
Name:SUZUKI, NOAH KIYOTAKA (LPC)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:KIYOTAKA
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S SMEDLEY ST APT 11
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6730
Mailing Address - Country:US
Mailing Address - Phone:917-684-9591
Mailing Address - Fax:
Practice Address - Street 1:1062 E LANCASTER AVE STE 2
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1568
Practice Address - Country:US
Practice Address - Phone:917-684-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016093101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor