Provider Demographics
NPI:1518210590
Name:BASINGER, SUZANNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BASINGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13350 W COLONIAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3964
Mailing Address - Country:US
Mailing Address - Phone:407-797-8310
Mailing Address - Fax:
Practice Address - Street 1:13350 W COLONIAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3964
Practice Address - Country:US
Practice Address - Phone:407-797-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical