Provider Demographics
NPI:1003337684
Name:BLITMAN, SUSI (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUSI
Middle Name:
Last Name:BLITMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10286 HARBOR INN CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5622
Mailing Address - Country:US
Mailing Address - Phone:954-547-3414
Mailing Address - Fax:
Practice Address - Street 1:2010 NW 150TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2887
Practice Address - Country:US
Practice Address - Phone:954-431-9838
Practice Address - Fax:954-779-2316
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15054101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH15054OtherMENTAL HEALTH COUNSELING LICENSE