Healthcare Provider Details

I. General information

NPI: 1427668383
Provider Name (Legal Business Name): SUZANNE MCREE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 BOUNDARY BLVD
ROTONDA WEST FL
33947-2522
US

IV. Provider business mailing address

8725 PLACIDA ROAD UNIT 7 PMB 137
PLACIDA FL
33946
US

V. Phone/Fax

Practice location:
  • Phone: 727-459-0257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: