MEDICARE: SUZANNE CLARK 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	1041C0700X	Clinical Social Worker	SW10663	FL

General Provider Information

NPI Number	:	1851644819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE CLARK LCSW

Provider Business Mailing Address
First Line	:	12216 PANAMA CITY BEACH PKWY STE D
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2728
Country	:	US
Telephone Number	:	850-655-7090
Fax Number	:

Provider Business Practice Location Address
First Line	:	12216 PANAMA CITY BEACH PKWY STE D
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2728
Country	:	US
Telephone Number	:	850-655-7090
Fax Number	:

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

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	04/02/2026

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Directions to “ SUZANNE CLARK LCSW” Practice Location

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