Provider Demographics
NPI:1639406531
Name:LAKE, SUZANNE EDITH (LMHC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:EDITH
Last Name:LAKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:E
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:9 POND LANE
Mailing Address - Street 2:SUITE 3A1
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3329
Mailing Address - Country:US
Mailing Address - Phone:978-505-8455
Mailing Address - Fax:978-369-0400
Practice Address - Street 1:DAMONMILL SQUARE
Practice Address - Street 2:9 POND LANE, SUITE 3A1
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-505-8455
Practice Address - Fax:978-369-0400
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8336101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health