Provider Demographics
NPI:1568412112
Name:DIMBATH, SUSAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DIMBATH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SW AKRON AVE
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2951
Mailing Address - Country:US
Mailing Address - Phone:772-463-1556
Mailing Address - Fax:772-463-1557
Practice Address - Street 1:428 SW AKRON AVE
Practice Address - Street 2:SUITE B-4
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2951
Practice Address - Country:US
Practice Address - Phone:772-463-1556
Practice Address - Fax:772-463-1557
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health