MEDICARE: SUSAN E. KURNER LCSW

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	101Y00000X	Counselor	SW7995	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	SW7995	FL
3	101YM0800X	Mental Health Counselor	SW7995	FL
4	101YS0200X	School Counselor	SW7995	FL
5	104100000X	Social Worker	SW7995	FL
6	1041C0700X	Clinical Social Worker	SW7995	FL
7	101YP2500X	Professional Counselor	SW7995	FL

General Provider Information

NPI Number	:	1801842679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E. KURNER LCSW

Provider Business Mailing Address
First Line	:	10149 FOX LAKE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1693
Country	:	US
Telephone Number	:	352-494-6857
Fax Number	:	888-346-3643

Provider Business Practice Location Address
First Line	:	10149 FOX LAKE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1693
Country	:	US
Telephone Number	:	352-494-6857
Fax Number	:	888-346-3643

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/31/2020

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