MEDICARE: CAMILA SUCHY

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	C017514	NC
2	1041C0700X	Clinical Social Worker	SW22198	FL

General Provider Information

NPI Number	:	1831715937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILA SUCHY

Provider Business Mailing Address
First Line	:	3025 WOODLAND HILLS AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4143
Country	:	US
Telephone Number	:	863-225-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 WOODLAND HILLS AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4143
Country	:	US
Telephone Number	:	863-225-2864
Fax Number	:

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	10/01/2024

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Directions to “ CAMILA SUCHY ” Practice Location

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