Provider Demographics
NPI:1558652636
Name:CREWS, SUSAN L
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:CREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:FL
Mailing Address - Zip Code:32619-0244
Mailing Address - Country:US
Mailing Address - Phone:386-717-6134
Mailing Address - Fax:
Practice Address - Street 1:4140 NW 27TH LN STE F
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6600
Practice Address - Country:US
Practice Address - Phone:386-717-6134
Practice Address - Fax:352-554-4929
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003466800Medicaid
FLMH10664OtherLICENSE