Provider Demographics
NPI:1104046150
Name:SEPIC, CORA SUSANA (ED, S,LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CORA
Middle Name:SUSANA
Last Name:SEPIC
Suffix:
Gender:F
Credentials:ED, S,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 SW 144TH ST
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1462
Mailing Address - Country:US
Mailing Address - Phone:305-234-8748
Mailing Address - Fax:305-234-8748
Practice Address - Street 1:8350 SW 144TH ST
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33158-1462
Practice Address - Country:US
Practice Address - Phone:305-234-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH 5012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty