Provider Demographics
NPI:1235297664
Name:ANKER, SUSAN CARRIE (LCSW,MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CARRIE
Last Name:ANKER
Suffix:
Gender:F
Credentials:LCSW,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 BOISE WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4865
Mailing Address - Country:US
Mailing Address - Phone:305-668-9090
Mailing Address - Fax:954-447-3894
Practice Address - Street 1:7800 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5528
Practice Address - Country:US
Practice Address - Phone:305-668-9090
Practice Address - Fax:954-447-3894
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00018431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3004AMedicare ID - Type Unspecified