Doctor Name: | MRS. SUSAN TABICMAN |
NPI Number: | 1013029248 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LMHC 4850 |
Business Practice Address: | 6400 Manatee Ave W Bradenton, FL - 342092378 |
Business Phone Number: | 9417049688 |
Business Fax Number: | |
Mailing Address: | 611 Ambassador Ln, HOLMES BEACH |
State: | FL |
Postal Code: | 342171209 |
Phone Number: | 9417783890 |
Fax Number: | |
NPI Enumeration Date: | 09/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LMHC 4850 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |