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General NPI Number Information
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NPI Number | 1013029248
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Entity Type | Individual
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Provider Name | MRS. SUSAN TABICMAN
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Gender | Female
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6400 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-2378
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Country | US
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Telephone | 941-704-9688
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Fax |
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Provider Business Mailing Address
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Address Line | 611 AMBASSADOR LN
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City | HOLMES BEACH
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State | FL
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Zip | 34217-1209
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Country | US
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Telephone | 941-778-3890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC 4850
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License Number State | FL
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