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General NPI Number Information
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NPI Number | 1518668003
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Entity Type | Individual
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Provider Name | SULEIDY FANA SUERO LCMHC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 3800 W BROWARD BLVD STE 100
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-1018
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Country | US
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Telephone | 352-744-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 NW 186TH ST APT 304
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City | HIALEAH
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State | FL
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Zip | 33015-8055
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Country | US
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Telephone | 786-442-9320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH21968
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License Number State | FL
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