Provider Demographics
NPI:1205177821
Name:ROKOSCH, SUSAN LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:ROKOSCH
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 1:4902 N MACDILL AVE APT 1010
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6789
Mailing Address - Country:US
Mailing Address - Phone:049-627-4564
Mailing Address - Fax:
Practice Address - Street 1:4902 N MACDILL AVE APT 1010
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6789
Practice Address - Country:US
Practice Address - Phone:904-627-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YA0400X
SC10197104100000X
FLSW159191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker