Provider Demographics
NPI:1003637141
Name:SORRENTINO, SUSAN (RBT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 MORNINGVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1285
Mailing Address - Country:US
Mailing Address - Phone:219-765-1497
Mailing Address - Fax:
Practice Address - Street 1:1349 MORNINGVIEW CT
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1285
Practice Address - Country:US
Practice Address - Phone:219-765-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-353719106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician