Provider Demographics
NPI:1386664324
Name:BREWER, SUE A (LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:BREWER
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 1:1700 PARK ST N
Mailing Address - Street 2:STE 109
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4356
Mailing Address - Country:US
Mailing Address - Phone:727-347-3680
Mailing Address - Fax:727-343-2400
Practice Address - Street 1:1700 PARK ST N
Practice Address - Street 2:STE 109
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4356
Practice Address - Country:US
Practice Address - Phone:727-347-3680
Practice Address - Fax:727-343-2400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3191Medicare ID - Type Unspecified