Provider Demographics
NPI:1831600196
Name:CARLSON, SUZANNE
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1419
Mailing Address - Country:US
Mailing Address - Phone:914-629-2857
Mailing Address - Fax:
Practice Address - Street 1:185 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1419
Practice Address - Country:US
Practice Address - Phone:914-629-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist