MEDICARE: MRS. SUSAN CAROL SCHANEN 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	SW3892	FL

General Provider Information

NPI Number	:	1922160282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN CAROL SCHANEN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 50726
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32240-0726
Country	:	US
Telephone Number	:	904-247-0090
Fax Number	:	904-247-0093

Provider Business Practice Location Address
First Line	:	1003 3RD ST N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7238
Country	:	US
Telephone Number	:	904-247-0090
Fax Number	:	904-247-0093

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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