Provider Demographics
NPI:1871968792
Name:SUSAN CARDIFF-REED, LCSW
Entity type:Organization
Organization Name:SUSAN CARDIFF-REED, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:CARDIFF-REED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-671-5726
Mailing Address - Street 1:2692 US1 SOUTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4909
Mailing Address - Country:US
Mailing Address - Phone:904-671-5726
Mailing Address - Fax:904-239-5522
Practice Address - Street 1:2692 US 1 S
Practice Address - Street 2:SUITE 110
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4903
Practice Address - Country:US
Practice Address - Phone:904-671-5726
Practice Address - Fax:904-239-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6980251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health