Provider Demographics
NPI:1275785487
Name:SUAREZ, CONCEPCION (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CONCEPCION
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 47TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7329
Mailing Address - Country:US
Mailing Address - Phone:646-796-7554
Mailing Address - Fax:
Practice Address - Street 1:5149 47TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7329
Practice Address - Country:US
Practice Address - Phone:646-796-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077744-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical