Provider Demographics
NPI:1619412491
Name:PERRY, SUNCERRAE (MSW, APSW, SAC-IT)
Entity Type:Individual
Prefix:
First Name:SUNCERRAE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW, APSW, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 W STATE ST
Mailing Address - Street 2:#193
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6650 W STATE ST
Practice Address - Street 2:#193
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2827
Practice Address - Country:US
Practice Address - Phone:414-732-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16958101YA0400X
WI129567104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker