Provider Demographics
NPI:1780739094
Name:TAYLOR, SUZAN THOMPSON (MSW)
Entity type:Individual
Prefix:MRS
First Name:SUZAN
Middle Name:THOMPSON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 DELTA WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4227
Mailing Address - Country:US
Mailing Address - Phone:850-656-1822
Mailing Address - Fax:850-656-2905
Practice Address - Street 1:2065 DELTA WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4227
Practice Address - Country:US
Practice Address - Phone:850-656-1822
Practice Address - Fax:850-656-2905
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0943Medicare ID - Type Unspecified