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NPI Code Detail

MEDICARE: MS. SUZANNE MARIE HENNESSEY LCSW

MEDICARE: MS. SUZANNE MARIE HENNESSEY 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
11041C0700XClinical Social WorkerSW 4560FL

General Provider Information

NPI Number : 1972556090
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUZANNE MARIE HENNESSEY LCSW
Provider Business Mailing Address
First Line : 624 STILL MEADOWS CIRCLE
Second Line : NORTH
City : PALM HARBOR
State : FL
Zip : 34683-5141
Country : US
Telephone Number : 727-787-1000
Fax Number : 727-771-9467
Provider Business Practice Location Address
First Line : 901 S 62ND AVE
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33023-1848
Country : US
Telephone Number : 954-893-0109
Fax Number : 954-893-9750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 09/23/2013

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