Provider Demographics
NPI:1316368277
Name:LAYNE, SUSAN MARGARET (MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARGARET
Last Name:LAYNE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 PALOMINO WAY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9303
Mailing Address - Country:US
Mailing Address - Phone:407-542-1391
Mailing Address - Fax:
Practice Address - Street 1:1482 PALOMINO WAY
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9303
Practice Address - Country:US
Practice Address - Phone:407-542-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906650251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health