Provider Demographics
NPI:1932280880
Name:STEWART PALMISANO, SUZANNE ELLEN (LPCC LICDC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELLEN
Last Name:STEWART PALMISANO
Suffix:
Gender:F
Credentials:LPCC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 ROCKSIDE RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2368
Mailing Address - Country:US
Mailing Address - Phone:216-524-2776
Mailing Address - Fax:216-524-2778
Practice Address - Street 1:6500 ROCKSIDE RD
Practice Address - Street 2:SUITE 390
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2368
Practice Address - Country:US
Practice Address - Phone:216-524-2776
Practice Address - Fax:216-524-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH841098101YA0400X
OHE2156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)