Provider Demographics
NPI:1356582639
Name:LONG, SUSAN KATHARINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHARINE
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:595 CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6141
Mailing Address - Country:US
Mailing Address - Phone:386-847-6435
Mailing Address - Fax:
Practice Address - Street 1:3150 CARDINAL DR STE 200
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1931
Practice Address - Country:US
Practice Address - Phone:386-847-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW66081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical