Provider Demographics
NPI:1265431282
Name:WHITE, SUE (DCSW, LCSW, CAP, PA)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DCSW, LCSW, CAP, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MADRUGA AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3148
Mailing Address - Country:US
Mailing Address - Phone:305-663-9080
Mailing Address - Fax:305-663-1084
Practice Address - Street 1:1450 MADRUGA AVE
Practice Address - Street 2:STE 304
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3148
Practice Address - Country:US
Practice Address - Phone:305-663-9080
Practice Address - Fax:305-663-1084
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker