Provider Demographics
NPI:1649642042
Name:PURICELLI, SUSANA BEATRIZ (MA)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:BEATRIZ
Last Name:PURICELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30209 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4249
Mailing Address - Country:US
Mailing Address - Phone:206-850-7584
Mailing Address - Fax:
Practice Address - Street 1:30209 21ST AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4249
Practice Address - Country:US
Practice Address - Phone:206-850-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-24
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60804720101YM0800X
106H00000X
WACL 60163927101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist