Provider Demographics
NPI:1588799613
Name:DAKOULAS, SUZANNE D (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:D
Last Name:DAKOULAS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GILCREAST RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053
Mailing Address - Country:US
Mailing Address - Phone:603-552-5125
Mailing Address - Fax:603-240-0611
Practice Address - Street 1:75 GILCREAST RD STE 200
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-552-5125
Practice Address - Fax:603-240-0611
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018812104100000X
NH1085104100000X
MA121788163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered163W00000XNursing Service ProvidersRegistered Nurse