Provider Demographics
NPI:1790002103
Name:BINGEL, SUSAN JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANE
Last Name:BINGEL
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 1:33057 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7506
Mailing Address - Country:US
Mailing Address - Phone:352-787-0081
Mailing Address - Fax:352-314-9444
Practice Address - Street 1:33057 PROFESSIONAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7506
Practice Address - Country:US
Practice Address - Phone:352-787-0081
Practice Address - Fax:352-314-9444
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW97761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical