Provider Demographics
NPI:1538244959
Name:PERRY, SUZANNE VICKNAIR (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:VICKNAIR
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 E CYPRESS POINT CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2284
Mailing Address - Country:US
Mailing Address - Phone:225-936-5512
Mailing Address - Fax:
Practice Address - Street 1:8555 E CYPRESS POINT CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2284
Practice Address - Country:US
Practice Address - Phone:225-936-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C376Medicare ID - Type Unspecified