Basic Information
| Provider Information | |||||||||
| NPI: | 1487818308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACQUEZ-SANCHEZ | ||||||||
| FirstName: | SUZANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5800 3RD AVE | ||||||||
| Address2: | LUTHERAN MEDICAL CENTER MANAGED CARE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112203702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186307477 | ||||||||
| FaxNumber: | 7186307437 | ||||||||
| Practice Location | |||||||||
| Address1: | 514 49TH ST | ||||||||
| Address2: | LUTHERAN MEDICAL CENTER-SUNSET TERRACE FHC | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112202010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188541851 | ||||||||
| FaxNumber: | 7184375239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2008 | ||||||||
| LastUpdateDate: | 04/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 065435 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 065435 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 079512-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.