MEDICARE: MS. SUSAN KATHARINE LONG 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	SW6608	FL

General Provider Information

NPI Number	:	1356582639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN KATHARINE LONG LCSW

Provider Business Mailing Address
First Line	:	595 CATALINA ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6141
Country	:	US
Telephone Number	:	386-847-6435
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 CARDINAL DR STE 200
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-1931
Country	:	US
Telephone Number	:	386-847-6435
Fax Number	:

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

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	02/01/2019

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