Provider Demographics
NPI:1063614816
Name:GOLD, SUZANNE (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 SW 77TH AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2618
Mailing Address - Country:US
Mailing Address - Phone:305-323-1994
Mailing Address - Fax:
Practice Address - Street 1:1320 S DIXIE HWY
Practice Address - Street 2:SUITE 1140
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2926
Practice Address - Country:US
Practice Address - Phone:305-668-9000
Practice Address - Fax:305-662-1788
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW42641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764205900Medicaid
FL763887600Medicaid