Provider Demographics
NPI:1831217389
Name:LOFTUS, SUSAN JANET (MSW, LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JANET
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 CENTRAL AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3703
Mailing Address - Country:US
Mailing Address - Phone:727-497-2993
Mailing Address - Fax:727-821-6440
Practice Address - Street 1:535 CENTRAL AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3703
Practice Address - Country:US
Practice Address - Phone:727-497-2993
Practice Address - Fax:727-821-6440
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW39711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6877AMedicare ID - Type Unspecified