MEDICARE: SUSAN CRAIG

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	MH 9422	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902822703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CRAIG

Provider Business Mailing Address
First Line	:	425 W COLONIAL DR
Second Line	:	SUITE 302
City	:	ORLANDO
State	:	FL
Zip	:	32804-6863
Country	:	US
Telephone Number	:	407-362-6003
Fax Number	:	407-362-6007

Provider Business Practice Location Address
First Line	:	425 W COLONIAL DR
Second Line	:	SUITE 302
City	:	ORLANDO
State	:	FL
Zip	:	32804-6863
Country	:	US
Telephone Number	:	407-362-6003
Fax Number	:	407-362-6007

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/07/2009

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Directions to “ SUSAN CRAIG ” Practice Location

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