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General NPI Number Information
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NPI Number | 1750588778
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Entity Type | Individual
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Provider Name | SANDRA BROSE SUZUKI LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 22904 LYDEN DR
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City | ESTERO
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State | FL
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Zip | 33928-7047
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Country | US
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Telephone | 239-494-3951
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Fax |
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Provider Business Mailing Address
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Address Line | 16184 EDGEMONT DR
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City | FORT MYERS
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State | FL
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Zip | 33908-3652
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Country | US
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Telephone | 847-284-0636
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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 | 180005930
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 24188
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License Number State | FL
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