Provider Demographics
NPI:1699788596
Name:SHAFRAN, SUSAN EVELYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:EVELYN
Last Name:SHAFRAN
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 1:5851 HOLMBERG RD
Mailing Address - Street 2:APT 2013
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4536
Mailing Address - Country:US
Mailing Address - Phone:718-314-5450
Mailing Address - Fax:
Practice Address - Street 1:1371 S OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7130
Practice Address - Country:US
Practice Address - Phone:954-943-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0734941041C0700X
NY0785721041C0700X
FLSW104451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical