MEDICARE: MS. SUSAN ELIZABETH WICK LCSW

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	0904014454	VA
2	1041C0700X	Clinical Social Worker	61745	TX
3	1041C0700X	Clinical Social Worker	TPSW267	FL

General Provider Information

NPI Number	:	1124682372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ELIZABETH WICK LCSW

Provider Business Mailing Address
First Line	:	2504 W. PARK ROW SUITE B-5-134
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013
Country	:	US
Telephone Number	:	817-275-1746
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 W. PARK ROW SUITE B-5-134
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013
Country	:	US
Telephone Number	:	817-275-1746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	03/17/2026

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