Provider Demographics
NPI:1508288077
Name:ESTEVEZ, SULLEZA (MSW)
Entity Type:Individual
Prefix:
First Name:SULLEZA
Middle Name:
Last Name:ESTEVEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SULLEZA
Other - Middle Name:
Other - Last Name:ESTEVEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:6015 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3472
Mailing Address - Country:US
Mailing Address - Phone:347-526-6345
Mailing Address - Fax:
Practice Address - Street 1:6015 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3472
Practice Address - Country:US
Practice Address - Phone:347-526-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health