Healthcare Provider Details

I. General information

NPI: 1588642649
Provider Name (Legal Business Name): MARLENE BELMONT SUKIENNIK L.C.S.W., A.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2006
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 N HAYDEN RD # I-108
SCOTTSDALE AZ
85260-5687
US

IV. Provider business mailing address

245 W WIEUCA NERD 140
ATLANTA GA
30342-3369
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3323
  • Fax: 602-938-1626
Mailing address:
  • Phone: 678-720-8921
  • Fax: 404-254-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number672
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number475
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12724
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: