Provider Demographics
NPI:1760828651
Name:BURCH, SUSAN S (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:S
Last Name:BURCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4231
Mailing Address - Country:US
Mailing Address - Phone:239-936-3165
Mailing Address - Fax:
Practice Address - Street 1:2266 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4231
Practice Address - Country:US
Practice Address - Phone:239-936-3165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker