Provider Demographics
NPI:1669799730
Name:SUNUKJIAN, MARIA (LCSWR)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SUNUKJIAN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SOUTH MARSHALL STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1903
Mailing Address - Country:US
Mailing Address - Phone:518-764-2815
Mailing Address - Fax:518-434-0434
Practice Address - Street 1:5 PINE WEST PLZ
Practice Address - Street 2:508
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5593
Practice Address - Country:US
Practice Address - Phone:518-764-2815
Practice Address - Fax:518-452-4233
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027213-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300017891Medicare PIN