Provider Demographics
NPI:1558559963
Name:PEKAREK, SUZANNE NICOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:NICOLE
Last Name:PEKAREK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1622
Mailing Address - Country:US
Mailing Address - Phone:850-651-2627
Mailing Address - Fax:850-863-5548
Practice Address - Street 1:123 TRUXTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2460
Practice Address - Country:US
Practice Address - Phone:850-863-1530
Practice Address - Fax:850-863-5548
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPPLICATIONMedicaid