Provider Demographics
NPI:1942855580
Name:BOBROW, SUSAN LEE (LGPC, NCC, RMHCI)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:BOBROW
Suffix:
Gender:F
Credentials:LGPC, NCC, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PAINTED PALM DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3372
Mailing Address - Country:US
Mailing Address - Phone:443-617-0711
Mailing Address - Fax:
Practice Address - Street 1:3049 CLEVELAND AVE STE 295
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7054
Practice Address - Country:US
Practice Address - Phone:813-754-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health