Provider Demographics
NPI:1104329903
Name:SUKYS-RICE, ELIZABETH LEAH (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEAH
Last Name:SUKYS-RICE
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 1:11395 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6207
Mailing Address - Country:US
Mailing Address - Phone:727-300-9382
Mailing Address - Fax:
Practice Address - Street 1:6251 PARK BLVD N STE 9
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3238
Practice Address - Country:US
Practice Address - Phone:727-300-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW151781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical