Basic Information
| Provider Information | |||||||||
| NPI: | 1215476684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUARA | ||||||||
| FirstName: | ZAINAB | ||||||||
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| OtherLastName: | SUARA | ||||||||
| OtherFirstName: | ZAINAB | ||||||||
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| OtherCredential: | MA, MSPH | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 BLOOMFIELD AVE | ||||||||
| Address2: | UNIT 3315 | ||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061171545 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 77 MILL ST | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010854598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135686141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2017 | ||||||||
| LastUpdateDate: | 02/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.