Provider Demographics
NPI:1730632340
Name:SUERO, MICHELLE DENICE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENICE
Last Name:SUERO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14910 TROPICAL VIOLET WAY
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-2427
Mailing Address - Country:US
Mailing Address - Phone:786-537-7942
Mailing Address - Fax:
Practice Address - Street 1:14910 TROPICAL VIOLET WAY
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2427
Practice Address - Country:US
Practice Address - Phone:786-537-7942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL13483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst