Provider Demographics
NPI:1821134693
Name:AMORE, SUSAN MEINERT (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MEINERT
Last Name:AMORE
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 1:5225 HIGH COLONY DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8415
Mailing Address - Country:US
Mailing Address - Phone:850-363-3382
Mailing Address - Fax:850-531-0380
Practice Address - Street 1:1931 WELBY WAY STE 5
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-363-3382
Practice Address - Fax:850-531-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-40121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7599544-00Medicaid