Provider Demographics
NPI:1992784276
Name:KRESIAK, SUZANNE MICHELE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MICHELE
Last Name:KRESIAK
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:MICHELE
Other - Last Name:LIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:25 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6722
Mailing Address - Country:US
Mailing Address - Phone:413-358-3551
Mailing Address - Fax:413-961-5455
Practice Address - Street 1:25 HENRY AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6722
Practice Address - Country:US
Practice Address - Phone:413-358-3551
Practice Address - Fax:413-961-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08566OtherBLUE CROSS BLUE SHIELD