Provider Demographics
NPI:1154699056
Name:SINICROPI-WALLACE, SUZANNE (LCSW-R)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SINICROPI-WALLACE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:SINICROPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:32 MAPLE DELL
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2952
Mailing Address - Country:US
Mailing Address - Phone:518-584-7905
Mailing Address - Fax:
Practice Address - Street 1:27 GICK RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8517
Practice Address - Country:US
Practice Address - Phone:518-581-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035535-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical