Provider Demographics
NPI:1912892399
Name:SOUFERIAN, SUZANNE (IMT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SOUFERIAN
Suffix:
Gender:F
Credentials:IMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 GRAND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2840 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2317
Practice Address - Country:US
Practice Address - Phone:305-857-0050
Practice Address - Fax:305-330-3209
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4280106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist