MEDICARE: MRS. KIRSTEN NICOLE SUAREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	106536	CA
2	103K00000X	Behavior Analyst	1-14-10192	CA

General Provider Information

NPI Number	:	1508117045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIRSTEN NICOLE SUAREZ

Provider Business Mailing Address
First Line	:	CENTRAL VALLEY (MERCED): USE DEPT LA 22763
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-0001
Country	:	US
Telephone Number	:	866-523-4268
Fax Number	:

Provider Business Practice Location Address
First Line	:	CENTRAL VALLEY (MERCED): USE DEPT LA 22763
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-4719
Country	:	US
Telephone Number	:	866-523-4268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	01/12/2023

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