Provider Demographics
NPI:1154174944
Name:SUENGA, GRETELL H (CBHCMP)
Entity type:Individual
Prefix:
First Name:GRETELL
Middle Name:H
Last Name:SUENGA
Suffix:
Gender:F
Credentials:CBHCMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 W 22ND CT APT 107
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3970
Mailing Address - Country:US
Mailing Address - Phone:786-296-6336
Mailing Address - Fax:
Practice Address - Street 1:6265 W 22ND CT APT 107
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3970
Practice Address - Country:US
Practice Address - Phone:786-296-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM0.105309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker