Provider Demographics
NPI:1578815510
Name:GALLUCCI, SUZAN M (MS, LMHC, BC-TMH)
Entity Type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:M
Last Name:GALLUCCI
Suffix:
Gender:F
Credentials:MS, LMHC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 IMMOKALEE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-4807
Mailing Address - Country:US
Mailing Address - Phone:239-860-5789
Mailing Address - Fax:
Practice Address - Street 1:1185 IMMOKALEE RD STE 220
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-4807
Practice Address - Country:US
Practice Address - Phone:239-860-5789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-14
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12150101YM0800X
FLMH17487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health