Healthcare Provider Details

I. General information

NPI: 1891624557
Provider Name (Legal Business Name): MS. SUZANNE PEKOW CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259A NORTH ST
HYANNIS MA
02601-3823
US

IV. Provider business mailing address

17 NORSE PINES DR
E SANDWICH MA
02537-1086
US

V. Phone/Fax

Practice location:
  • Phone: 508-862-0514
  • Fax:
Mailing address:
  • Phone: 612-559-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: