Healthcare Provider Details

I. General information

NPI: 1205177821
Provider Name (Legal Business Name): SUSAN LEE ROKOSCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 N MACDILL AVE APT 1010
TAMPA FL
33614-6789
US

IV. Provider business mailing address

4902 N MACDILL AVE APT 1010
TAMPA FL
33614-6789
US

V. Phone/Fax

Practice location:
  • Phone: 904-627-4564
  • Fax:
Mailing address:
  • Phone: 49-627-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10197
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: