Provider Demographics
NPI:1205148582
Name:CANTAVE-LABISSIERE, SUZE MARIE II (MS,COUNSELING)
Entity type:Individual
Prefix:MRS
First Name:SUZE
Middle Name:MARIE
Last Name:CANTAVE-LABISSIERE
Suffix:II
Gender:F
Credentials:MS,COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 EAST 104 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:917-440-0949
Mailing Address - Fax:
Practice Address - Street 1:1263 E 104TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4505
Practice Address - Country:US
Practice Address - Phone:917-440-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist