MEDICARE: SUSAN J. ROSEN WOLFSON 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	SW5613	FL

General Provider Information

NPI Number	:	1902880305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J. ROSEN WOLFSON LCSW

Provider Business Mailing Address
First Line	:	7321 LOBLOLLY BAY TRL
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-4169
Country	:	US
Telephone Number	:	941-962-0577
Fax Number	:

Provider Business Practice Location Address
First Line	:	3657 CORTEZ RD W
Second Line	:	SUITE 130
City	:	BRADENTON
State	:	FL
Zip	:	34210-3106
Country	:	US
Telephone Number	:	941-962-0577
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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