Provider Demographics
NPI:1922756790
Name:SONNI, SUSAN W (MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:W
Last Name:SONNI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 CARR 176 APT 53
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6612
Mailing Address - Country:US
Mailing Address - Phone:787-612-6912
Mailing Address - Fax:
Practice Address - Street 1:500 AVE MUNOZ RIVERA STE 248
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3346
Practice Address - Country:US
Practice Address - Phone:787-612-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3409103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool