Provider Demographics
NPI:1255773131
Name:SILVIA, SUZY GRANEROS (LCSW, MSW,)
Entity type:Individual
Prefix:
First Name:SUZY
Middle Name:GRANEROS
Last Name:SILVIA
Suffix:
Gender:F
Credentials:LCSW, MSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3929
Mailing Address - Country:US
Mailing Address - Phone:910-599-4545
Mailing Address - Fax:
Practice Address - Street 1:3807 WRIGHTSVILLE AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8441
Practice Address - Country:US
Practice Address - Phone:910-547-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health