Healthcare Provider Details

I. General information

NPI: 1912442203
Provider Name (Legal Business Name): DBA SUSAN ANKER,LCSW,MSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 N KENDALL DR SUITE 106
MIAMI FL
33176-1044
US

IV. Provider business mailing address

11440 N KENDALL DR SUITE 106
MIAMI FL
33176-1044
US

V. Phone/Fax

Practice location:
  • Phone: 305-668-9090
  • Fax: 954-447-3894
Mailing address:
  • Phone: 305-668-9090
  • Fax: 954-447-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW0001843
License Number StateFL

VIII. Authorized Official

Name: MRS. SUSAN ANKER
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 305-668-9090