Provider Demographics
NPI:1992891964
Name:ALEXANDER, SUZAN GWEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:GWEN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2555 ENTERPRISE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763
Mailing Address - Country:US
Mailing Address - Phone:727-215-2375
Mailing Address - Fax:727-796-2712
Practice Address - Street 1:2555 ENTERPRISE RD
Practice Address - Street 2:STE 2
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763
Practice Address - Country:US
Practice Address - Phone:727-215-2375
Practice Address - Fax:727-796-2712
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSW2842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24440Medicare ID - Type Unspecified