Provider Demographics
NPI:1134265358
Name:ROGER F SUCLUPE
Entity type:Organization
Organization Name:ROGER F SUCLUPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:SUCLUPE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:704-618-4189
Mailing Address - Street 1:8263 DEER DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9630
Mailing Address - Country:US
Mailing Address - Phone:704-618-4189
Mailing Address - Fax:
Practice Address - Street 1:4351 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7476
Practice Address - Country:US
Practice Address - Phone:704-618-4189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty