Provider Demographics
NPI:1922579069
Name:SUSAN WEXLER CRATER LCSW LLC
Entity Type:Organization
Organization Name:SUSAN WEXLER CRATER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:WEXLER
Authorized Official - Last Name:CRATER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-961-8852
Mailing Address - Street 1:4821 ROYAL DORNOCH CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-8444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9114 58TH DR E STE 114
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-9074
Practice Address - Country:US
Practice Address - Phone:941-961-8852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty