Breanna Suppi
Individual provider Active NPI Social Worker · Elmer, NJ
NPI 1346004264 · NPPES record last updated Feb 12, 2024
Key facts
- NPI
- 1346004264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 44SL06866900 (NJ)
- Practice address
- 1071 Rainbow Cir
Elmer, NJ 08318-9167 - Phone
- (650) 388-0746
- NPI assigned
- Feb 12, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SL06866900 | NJ | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 44SL06866900 | NJ | Yes |
Addresses
Primary practice location
1071 Rainbow Cir
Elmer, NJ 08318-9167
Mailing address
1071 Rainbow Cir
Elmer, NJ 08318-9167
Phone (856) 777-0767
Other providers in Elmer, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.