MEDICARE: MISS SUSAN ELIZABETH HARDWICKE LISW CP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	5513	SC

General Provider Information

NPI Number	:	1295888089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SUSAN ELIZABETH HARDWICKE LISW CP

Provider Business Mailing Address
First Line	:	2418 DEVINE ST
Second Line	:	STE 104
City	:	COLUMBIA
State	:	SC
Zip	:	29205
Country	:	US
Telephone Number	:	803-920-4491
Fax Number	:	803-256-5020

Provider Business Practice Location Address
First Line	:	2418 DEVINE ST
Second Line	:	STE 104
City	:	COLUMBIA
State	:	SC
Zip	:	29205
Country	:	US
Telephone Number	:	803-920-4491
Fax Number	:	803-256-5020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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