Provider Demographics
NPI:1134162548
Name:LEE, SUSAN BARRETT (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BARRETT
Last Name:LEE
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 1:5632 SE SCHOONER OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-2524
Mailing Address - Country:US
Mailing Address - Phone:772-223-0719
Mailing Address - Fax:
Practice Address - Street 1:5632 SE SCHOONER OAKS WAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-2524
Practice Address - Country:US
Practice Address - Phone:772-223-0719
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW40091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6856AMedicare ID - Type Unspecified