Provider Demographics
NPI:1588841449
Name:SUE A BREWER INC
Entity type:Organization
Organization Name:SUE A BREWER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-347-3680
Mailing Address - Street 1:1700 PARK ST N
Mailing Address - Street 2:#109
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4356
Mailing Address - Country:US
Mailing Address - Phone:727-347-3680
Mailing Address - Fax:727-343-2400
Practice Address - Street 1:1700 PARK ST N
Practice Address - Street 2:#109
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4356
Practice Address - Country:US
Practice Address - Phone:727-347-3680
Practice Address - Fax:727-343-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty