Provider Demographics
NPI:1508950478
Name:SPEROPULOS, SUSAN L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:SPEROPULOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3919 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9378
Mailing Address - Country:US
Mailing Address - Phone:850-503-0002
Mailing Address - Fax:
Practice Address - Street 1:4453 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2066
Practice Address - Country:US
Practice Address - Phone:850-905-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ103EOtherBCBS OF FL
FLU6830AMedicare ID - Type Unspecified