Provider Demographics
NPI:1205041365
Name:WERTHEIM, SUSAN R S (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R S
Last Name:WERTHEIM
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 1:1801 HILLMOOR DRIVE
Mailing Address - Street 2:SUITE A-107
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7545
Mailing Address - Country:US
Mailing Address - Phone:772-335-7398
Mailing Address - Fax:772-335-2089
Practice Address - Street 1:1801 HILLMOOR DRIVE
Practice Address - Street 2:SUITE A-107
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7545
Practice Address - Country:US
Practice Address - Phone:772-335-7398
Practice Address - Fax:772-335-7398
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00016231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical