Provider Demographics
NPI:1548486475
Name:PATALANO, SUZAN PAULA (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:PAULA
Last Name:PATALANO
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 E TUCKEY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1333
Mailing Address - Country:US
Mailing Address - Phone:602-294-0380
Mailing Address - Fax:
Practice Address - Street 1:4612 N 28TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4931
Practice Address - Country:US
Practice Address - Phone:602-764-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW - 01771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical