Provider Demographics
NPI:1578710224
Name:LARLHAM, SUZANNE (PCNS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LARLHAM
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5018
Mailing Address - Country:US
Mailing Address - Phone:401-248-5288
Mailing Address - Fax:401-294-5579
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5018
Practice Address - Country:US
Practice Address - Phone:401-248-5288
Practice Address - Fax:401-294-5579
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI33534163WP0809X
RIAPRN01000364SP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health