Provider Demographics
NPI:1396145702
Name:CASABIANCA, SUZETTE M (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:M
Last Name:CASABIANCA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 883
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34673
Mailing Address - Country:US
Mailing Address - Phone:727-597-3303
Mailing Address - Fax:727-754-4230
Practice Address - Street 1:2708 ALT 19
Practice Address - Street 2:#507-10
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2665
Practice Address - Country:US
Practice Address - Phone:727-597-3303
Practice Address - Fax:727-865-5150
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT-2922106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist