Provider Demographics
NPI:1538484274
Name:SUCKERMAN, SIVIE (LMHC)
Entity Type:Individual
Prefix:
First Name:SIVIE
Middle Name:
Last Name:SUCKERMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 GILMAN AVE W
Mailing Address - Street 2:301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2379
Mailing Address - Country:US
Mailing Address - Phone:206-954-9858
Mailing Address - Fax:206-629-9424
Practice Address - Street 1:2105 112TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2945
Practice Address - Country:US
Practice Address - Phone:206-954-9858
Practice Address - Fax:206-629-9424
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60177889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health