Provider Demographics
NPI:1780006296
Name:SUAREZ, VANESSA A (MA, LADC)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:A
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 S 37TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6106
Mailing Address - Country:US
Mailing Address - Phone:402-416-2118
Mailing Address - Fax:
Practice Address - Street 1:4719 PRESCOTT AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5456
Practice Address - Country:US
Practice Address - Phone:402-413-9147
Practice Address - Fax:402-261-7149
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1302101YA0400X
NEP-1123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470398819Medicaid