Provider Demographics
NPI:1770534356
Name:GERTRUDES, SUZANA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SUZANA
Middle Name:
Last Name:GERTRUDES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUZANA
Other - Middle Name:
Other - Last Name:DASILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:204B GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3246
Mailing Address - Country:US
Mailing Address - Phone:401-374-1460
Mailing Address - Fax:
Practice Address - Street 1:261 WICKENDEN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4422
Practice Address - Country:US
Practice Address - Phone:401-374-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW015221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical