MEDICARE: MRS. NIKKI SANUSI LCSW-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	40695	TX

General Provider Information

NPI Number	:	1427308089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIKKI SANUSI LCSW-S

Provider Business Mailing Address
First Line	:	2404 S GRAND BLVD
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-4299
Country	:	US
Telephone Number	:	832-304-1846
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 S GRAND BLVD
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-4299
Country	:	US
Telephone Number	:	832-304-1846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	08/23/2024

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