MEDICARE: SUZANNA KIDD 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	C009283	NC

General Provider Information

NPI Number	:	1396256624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNA KIDD LCSW

Provider Business Mailing Address
First Line	:	301 E WENDOVER AVE STE 310
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1231
Country	:	US
Telephone Number	:	336-832-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 E WENDOVER AVE STE 310
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1231
Country	:	US
Telephone Number	:	336-832-3070
Fax Number	:

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

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	10/13/2017

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Directions to “ SUZANNA KIDD LCSW” Practice Location

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