Healthcare Provider Details

I. General information

NPI: 1831015809
Provider Name (Legal Business Name): SUZETTE DANIEL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SOUTH AVE
STATEN ISLAND NY
10314-3403
US

IV. Provider business mailing address

10 MADISON AVE
AVENEL NJ
07001-1419
US

V. Phone/Fax

Practice location:
  • Phone: 917-636-3450
  • Fax:
Mailing address:
  • Phone: 848-482-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: