Provider Demographics
NPI:1952554669
Name:MCCOIN, SUSANNE BURKES (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:BURKES
Last Name:MCCOIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10310 NE 120TH ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-7454
Mailing Address - Country:US
Mailing Address - Phone:863-634-0754
Mailing Address - Fax:
Practice Address - Street 1:10310 NE 120TH ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-7454
Practice Address - Country:US
Practice Address - Phone:863-634-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 62011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7620543 00Medicaid