Provider Demographics
NPI:1760951974
Name:KATIFEDENIOS, SUZANNE
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:KATIFEDENIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 49TH ST N STE 106
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5332
Mailing Address - Country:US
Mailing Address - Phone:727-544-0044
Mailing Address - Fax:
Practice Address - Street 1:2792 PEACHTREE CIR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3838
Practice Address - Country:US
Practice Address - Phone:484-767-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)