Provider Demographics
NPI:1396197315
Name:SUAREZ, LUIS (MHC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4349
Mailing Address - Country:US
Mailing Address - Phone:631-428-7639
Mailing Address - Fax:
Practice Address - Street 1:34 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-4349
Practice Address - Country:US
Practice Address - Phone:631-428-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)