Provider Demographics
NPI:1700941481
Name:SUH, LOIS (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:MIKYUNG
Other - Middle Name:ALOISHA
Other - Last Name:SUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6039
Mailing Address - Country:US
Mailing Address - Phone:831-884-1000
Mailing Address - Fax:
Practice Address - Street 1:201 9TH ST
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6039
Practice Address - Country:US
Practice Address - Phone:831-884-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002593171100000X
NY020003225700000X
NY0711741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist