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General NPI Number Information
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NPI Number | 1417254483
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Entity Type | Individual
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Provider Name | SUSAN ANNE CHANCE LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/27/2011
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Last Update Date | 02/27/2011
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Provider Practice Location Address
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Address Line | 555 W GRANADA BLVD SUITE B-12
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9485
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Country | US
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Telephone | 386-290-8269
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Fax |
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Provider Business Mailing Address
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Address Line | 6 HOLLY FERN CHASE
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2413
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Country | US
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Telephone | 386-290-8269
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 10152
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License Number State | FL
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