Provider Demographics
NPI:1467529537
Name:SWANSON, SUZANNE CAROL (RNC MS LCDS)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:CAROL
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RNC MS LCDS
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:CAROL
Other - Last Name:ASHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TCN
Mailing Address - Street 1:225 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1218
Mailing Address - Country:US
Mailing Address - Phone:401-431-9800
Mailing Address - Fax:401-431-9801
Practice Address - Street 1:225 NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1218
Practice Address - Country:US
Practice Address - Phone:401-431-9800
Practice Address - Fax:401-431-9801
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00037101YA0400X, 101YM0800X
RIRN11335163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse