Provider Demographics
NPI:1740979418
Name:SPERRAZZA, SUSAN (BA, LMSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:SPERRAZZA
Suffix:
Gender:F
Credentials:BA, LMSW
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:TOMSIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, LMSW
Mailing Address - Street 1:171 SOUTHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223
Mailing Address - Country:US
Mailing Address - Phone:716-310-3186
Mailing Address - Fax:
Practice Address - Street 1:7311 PORTER ROAD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304
Practice Address - Country:US
Practice Address - Phone:716-310-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069376104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker