Healthcare Provider Details

I. General information

NPI: 1689747404
Provider Name (Legal Business Name): TOYOICHIRO SUZUKI PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTON SOUND HEALTH CORPORATION 306 W 5TH AVE
NOME AK
99762-0966
US

IV. Provider business mailing address

PO BOX 179
NOME AK
99762-0179
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3344
  • Fax: 907-443-5915
Mailing address:
  • Phone: 907-443-3344
  • Fax: 907-443-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number563
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: