Provider Demographics
NPI:1093002016
Name:SCW PSYCHOLOGICAL, INC
Entity Type:Organization
Organization Name:SCW PSYCHOLOGICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-528-8808
Mailing Address - Street 1:PO BOX 348220
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33234-8220
Mailing Address - Country:US
Mailing Address - Phone:305-528-8808
Mailing Address - Fax:305-454-0511
Practice Address - Street 1:1550 MADRUGA AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3039
Practice Address - Country:US
Practice Address - Phone:305-528-8808
Practice Address - Fax:305-454-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty