Provider Demographics
NPI:1073663118
Name:SUITERS, JENNIFER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SUITERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1644
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1644
Mailing Address - Country:US
Mailing Address - Phone:352-848-3760
Mailing Address - Fax:352-848-3761
Practice Address - Street 1:1038 SO PALM AVE
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448
Practice Address - Country:US
Practice Address - Phone:352-848-3760
Practice Address - Fax:352-848-3761
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811549400Medicaid
FLSW6272OtherLCSW
FLE5743Medicare ID - Type Unspecified