Provider Demographics
NPI:1134660632
Name:NOZICK, SUZETTE (LGPC)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:NOZICK
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W CHESAPEAKE AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4405
Mailing Address - Country:US
Mailing Address - Phone:410-497-6079
Mailing Address - Fax:
Practice Address - Street 1:304 W CHESAPEAKE AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4405
Practice Address - Country:US
Practice Address - Phone:410-497-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health