Healthcare Provider Details

I. General information

NPI: 1215800800
Provider Name (Legal Business Name): SUSI BURNEO RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 04/23/2026
Reactivation Date: 05/12/2026

III. Provider practice location address

850 NE 125TH ST
NORTH MIAMI FL
33161-5718
US

IV. Provider business mailing address

106 NW 135TH WAY UNIT 302
PLANTATION FL
33325-7700
US

V. Phone/Fax

Practice location:
  • Phone: 954-868-8500
  • Fax:
Mailing address:
  • Phone: 954-868-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26778
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: