Healthcare Provider Details

I. General information

NPI: 1871968792
Provider Name (Legal Business Name): SUSAN CARDIFF-REED, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2692 US 1 S SUITE 110
ST AUGUSTINE FL
32086-4903
US

IV. Provider business mailing address

2692 US1 SOUTH SUITE 110
ST. AUGUSTINE FL
32086-4909
US

V. Phone/Fax

Practice location:
  • Phone: 904-671-5726
  • Fax: 904-239-5522
Mailing address:
  • Phone: 904-671-5726
  • Fax: 904-239-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSW6980
License Number StateFL

VIII. Authorized Official

Name: SUSAN PATRICIA CARDIFF-REED
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 904-671-5726