MEDICARE: SUSAN CORBETT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SWL141	FL

General Provider Information

NPI Number	:	1053562744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN CORBETT INC

Provider Business Mailing Address
First Line	:	2247 GOLDENROD ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5318
Country	:	US
Telephone Number	:	941-926-8080
Fax Number	:	888-664-2547

Provider Business Practice Location Address
First Line	:	4067A S TAMIAMI TRL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-3623
Country	:	US
Telephone Number	:	941-926-8080
Fax Number	:	888-664-2547

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. SUSAN CORBETT
Credential	:	LCSW, BCD
Telephone Number	:	941-926-8080

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/10/2008

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