Provider Demographics
NPI:1679719793
Name:NIERENBERG, SUSAN LINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LINDA
Last Name:NIERENBERG
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 1:9700 S DIXIE HWY
Mailing Address - Street 2:SUITE 650
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2800
Mailing Address - Country:US
Mailing Address - Phone:305-670-1911
Mailing Address - Fax:305-670-2049
Practice Address - Street 1:9700 S DIXIE HWY
Practice Address - Street 2:SUITE 650
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2800
Practice Address - Country:US
Practice Address - Phone:305-670-1911
Practice Address - Fax:305-670-2049
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW43601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578522961Medicaid