MEDICARE: SUSAN WEXLER CRATER LCSW LLC

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

General Provider Information

NPI Number	:	1922579069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN WEXLER CRATER LCSW LLC

Provider Business Mailing Address
First Line	:	4821 ROYAL DORNOCH CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-8444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9114 58TH DR E STE 114
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-9074
Country	:	US
Telephone Number	:	941-961-8852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN WEXLER CRATER
Credential	:	LCSW
Telephone Number	:	941-961-8852

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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