Provider Demographics
NPI:1023339579
Name:SUZETTE SMITH LCSW INC
Entity type:Organization
Organization Name:SUZETTE SMITH LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-769-6188
Mailing Address - Street 1:1103 FORTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1831
Mailing Address - Country:US
Mailing Address - Phone:850-769-6188
Mailing Address - Fax:850-769-2366
Practice Address - Street 1:1103 FORTUNE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1831
Practice Address - Country:US
Practice Address - Phone:850-769-6188
Practice Address - Fax:850-769-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW91701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23797Medicare PIN