Healthcare Provider Details

I. General information

NPI: 1588837652
Provider Name (Legal Business Name): SUZANNE L CAVALIER- DORSETT L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1557
  • Fax:
Mailing address:
  • Phone: 480-262-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12426
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: