MEDICARE: SUZANNE MARIE CARSON LMT

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	172V00000X	Community Health Worker	MA54866	FL

General Provider Information

NPI Number	:	1487975892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE MARIE CARSON LMT

Provider Business Mailing Address
First Line	:	1345 ARLINGTON AVE
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5401
Country	:	US
Telephone Number	:	321-604-9616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 ARLINGTON AVE
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5401
Country	:	US
Telephone Number	:	321-604-9616
Fax Number	:

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

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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