MEDICARE: SUSAN COBB L.C.S.W

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	101YM0800X	Mental Health Counselor	SW5181	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z9775	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1295795441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN COBB L.C.S.W

Provider Business Mailing Address
First Line	:	1110 E GIBSON ST
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-5011
Country	:	US
Telephone Number	:	863-494-6222
Fax Number	:	863-494-3227

Provider Business Practice Location Address
First Line	:	1110 E GIBSON ST
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-5011
Country	:	US
Telephone Number	:	863-494-6222
Fax Number	:	863-494-3227

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/09/2007

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