Provider Demographics
NPI:1487012894
Name:COOTE, SUZANNE WALTMAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:WALTMAN
Last Name:COOTE
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 1:127 ABERCORN ST STE 301B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-4069
Mailing Address - Country:US
Mailing Address - Phone:833-232-6638
Mailing Address - Fax:833-569-3858
Practice Address - Street 1:127 ABERCORN ST
Practice Address - Street 2:SUITE 301B
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401
Practice Address - Country:US
Practice Address - Phone:833-232-6638
Practice Address - Fax:833-232-6638
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0031251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I800902Medicare PIN