Provider Demographics
NPI:1467566026
Name:DAVIS, SUSAN RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RUTH
Last Name:DAVIS
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 1:21300 COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1757
Mailing Address - Country:US
Mailing Address - Phone:561-852-3333
Mailing Address - Fax:561-852-3332
Practice Address - Street 1:21300 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1757
Practice Address - Country:US
Practice Address - Phone:561-852-3333
Practice Address - Fax:561-852-3332
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW65871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7891Medicare PIN