Provider Demographics
NPI:1699023267
Name:DIONNE, SUZANNE B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:B
Last Name:DIONNE
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 1:168 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-282-3351
Mailing Address - Fax:207-282-8733
Practice Address - Street 1:168 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3841
Practice Address - Country:US
Practice Address - Phone:207-282-3351
Practice Address - Fax:207-282-8733
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC150951041C0700X
MEMC12685104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical