Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW2323 | FL |
NPI | 1003230657 |
---|---|
Provider Name | Susan Lee |
First Address | Jacksonville, FL 32225-2687 |
Second Address | Jacksonville, FL 32225-1536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2014 |
Last Update Date | 16/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SW2323 | STATE LICENSE (01) | FL |