Provider Demographics
NPI:1710245733
Name:BRAMER, SUSAN ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BRAMER
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 1:13019 LORNA PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2908
Mailing Address - Country:US
Mailing Address - Phone:813-960-5112
Mailing Address - Fax:
Practice Address - Street 1:4014 GUNN HWY
Practice Address - Street 2:SUITE 95
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8724
Practice Address - Country:US
Practice Address - Phone:813-304-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical