Provider Demographics
NPI:1487818308
Name:JACQUEZ-SANCHEZ, SUZANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANN
Middle Name:
Last Name:JACQUEZ-SANCHEZ
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 1:5800 3RD AVE
Mailing Address - Street 2:LUTHERAN MEDICAL CENTER MANAGED CARE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3702
Mailing Address - Country:US
Mailing Address - Phone:718-630-7477
Mailing Address - Fax:718-630-7437
Practice Address - Street 1:514 49TH ST
Practice Address - Street 2:LUTHERAN MEDICAL CENTER-SUNSET TERRACE FHC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2010
Practice Address - Country:US
Practice Address - Phone:718-854-1851
Practice Address - Fax:718-437-5239
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065435104100000X, 1041C0700X
NY079512-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker