Provider Demographics
NPI:1285765784
Name:SUCRE, JEANNETTE A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:A
Last Name:SUCRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 HAMILTON PL APT 101
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6813
Mailing Address - Country:US
Mailing Address - Phone:212-933-1865
Mailing Address - Fax:212-933-1865
Practice Address - Street 1:35 HAMILTON PL APT 101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-6813
Practice Address - Country:US
Practice Address - Phone:212-933-1865
Practice Address - Fax:212-933-1865
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090988-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY136167177OtherFIDELIS