Provider Demographics
NPI:1689631277
Name:LESURE, SUZANNE (PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LESURE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2826
Mailing Address - Country:US
Mailing Address - Phone:330-418-7887
Mailing Address - Fax:330-776-5557
Practice Address - Street 1:4475 VALLEY FORGE DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2826
Practice Address - Country:US
Practice Address - Phone:330-418-7887
Practice Address - Fax:330-776-5557
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0607329Medicaid
OH0607329Medicaid