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General NPI Number Information
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NPI Number | 1639711690
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Entity Type | Individual
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Provider Name | CRISTINA LYN SUITCA MSW, LISW
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Gender | Female
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 2011 GLAMORGAN ST STE B
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City | ALLIANCE
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State | OH
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Zip | 44601-2709
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Country | US
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Telephone | 330-614-2777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2688
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City | ALLIANCE
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State | OH
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Zip | 44601-0688
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Country | US
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Telephone | 330-680-9020
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1901842
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License Number State | OH
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