MEDICARE: MS. VALERIE JOY SUDDUTH LCSW

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	101YM0800X	Mental Health Counselor	LCS9264	CA

General Provider Information

NPI Number	:	1558461038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE JOY SUDDUTH LCSW

Provider Business Mailing Address
First Line	:	100 DOYLE ST
Second Line	:	SUITE B
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2129
Country	:	US
Telephone Number	:	831-458-1040
Fax Number	:	831-426-1598

Provider Business Practice Location Address
First Line	:	100 DOYLE ST
Second Line	:	SUITE B
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2129
Country	:	US
Telephone Number	:	831-458-1040
Fax Number	:	831-426-1598

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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