Provider Demographics
NPI:1619062262
Name:SUZNOVICH, ALLISON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:SUZNOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CADILLAC DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8350
Mailing Address - Country:US
Mailing Address - Phone:916-342-4576
Mailing Address - Fax:916-443-3007
Practice Address - Street 1:25 CADILLAC DR STE 106
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8350
Practice Address - Country:US
Practice Address - Phone:916-342-4576
Practice Address - Fax:916-443-3007
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical