Provider Demographics
NPI:1386829695
Name:SUSAN J. ROSEN WOLFSON LLC
Entity Type:Organization
Organization Name:SUSAN J. ROSEN WOLFSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-962-0577
Mailing Address - Street 1:7321 LOBLOLLY BAY TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4169
Mailing Address - Country:US
Mailing Address - Phone:941-962-0577
Mailing Address - Fax:
Practice Address - Street 1:3657 CORTEZ RD W
Practice Address - Street 2:SUITE 130
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3106
Practice Address - Country:US
Practice Address - Phone:941-962-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5613251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health