Provider Demographics
NPI:1841854940
Name:MARRIOTT, SUZETTE (LCSW, CGP)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:LCSW, CGP
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:MARRIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 KERBEY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1455
Mailing Address - Country:US
Mailing Address - Phone:512-663-5777
Mailing Address - Fax:
Practice Address - Street 1:3400 KERBEY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1455
Practice Address - Country:US
Practice Address - Phone:512-663-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical