Provider Demographics
NPI:1689223562
Name:SULIT, MARIE DANIELLE (LSW)
Entity Type:Individual
Prefix:
First Name:MARIE DANIELLE
Middle Name:
Last Name:SULIT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7154 S BRONCO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4692
Mailing Address - Country:US
Mailing Address - Phone:732-343-1398
Mailing Address - Fax:
Practice Address - Street 1:1240 W OWENS AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2452
Practice Address - Country:US
Practice Address - Phone:702-483-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8487-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical