Provider Demographics
NPI:1043036379
Name:SUSAN SHAFRAN LLC
Entity type:Organization
Organization Name:SUSAN SHAFRAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-314-5450
Mailing Address - Street 1:55 SW 2ND AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4763
Mailing Address - Country:US
Mailing Address - Phone:718-314-5450
Mailing Address - Fax:954-507-6748
Practice Address - Street 1:55 SW 2ND AVE APT 403
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4763
Practice Address - Country:US
Practice Address - Phone:718-314-5450
Practice Address - Fax:954-507-6748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3ZMMOtherFL BLUE#
FLGT188AOtherPTAN/MEDICARE