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NPI Code Detail

MEDICARE: DIANNA M SUSITTI LCSW

MEDICARE: DIANNA M SUSITTI LCSW
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
1104100000XSocial Worker349123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477653533
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNA M SUSITTI LCSW
Provider Business Mailing Address
First Line : 2717 N GRANDVIEW BLVD
Second Line : # 202
City : WAUKESHA
State : WI
Zip : 53188
Country : US
Telephone Number : 262-513-0700
Fax Number : 262-513-0707
Provider Business Practice Location Address
First Line : 7330 W LAYTON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53220-3849
Country : US
Telephone Number : 414-877-4570
Fax Number : 262-228-6257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 04/24/2023

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