MEDICARE: MS. VICKI SUZANNE KLEIN 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	SW1592	FL

General Provider Information

NPI Number	:	1164415592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI SUZANNE KLEIN LCSW

Provider Business Mailing Address
First Line	:	3205 SOUTHGATE CIR
Second Line	:	STE 21
City	:	SARASOTA
State	:	FL
Zip	:	34239-5514
Country	:	US
Telephone Number	:	941-366-4400
Fax Number	:	941-366-4400

Provider Business Practice Location Address
First Line	:	3205 SOUTHGATE CIR
Second Line	:	STE 21
City	:	SARASOTA
State	:	FL
Zip	:	34239-5514
Country	:	US
Telephone Number	:	941-366-4400
Fax Number	:	941-366-4400

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	10/13/2009

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