Provider Demographics
NPI:1902190192
Name:MILANO, SUZANNE M (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:MILANO
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 1:2429 SE ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5252
Mailing Address - Country:US
Mailing Address - Phone:772-878-8007
Mailing Address - Fax:
Practice Address - Street 1:2429 SE ALDEN ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5252
Practice Address - Country:US
Practice Address - Phone:772-878-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional