Individual provider Active NPI

Susan Becker, LCSW

  • Clinical Social Worker
  • Clearwater, FL
National Provider Identifier
1558474098
Registry record updated Jan 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW7613 Issued in FL
Practice address
14041 Icot Blvd
Clearwater, FL 33760-3702
Phone
(727) 479-1897
Fax
(727) 479-1248
NPI assigned
Aug 17, 2006
Last updated
Jan 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW7613 FL Primary

Addresses

Primary practice location

14041 Icot Blvd
Clearwater, FL 33760-3702

Mailing address

PO Box 917770
Orlando, FL 32891-7770

Other identifiers 1

IdentifierTypeStateIssuer
Z067QOtherFLBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041020000646 FL Practitioner - Clinical Social Worker 4688635964 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Perelman School of Med at the University of Pennsylvania, 1968
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Life Solutions ServicesGroup PAC ID 1052656618, 8 clinicians

Practice addresses (Care Compare)

710 Oakfield Dr
Suite 206
Brandon, FL 33511-4954
Phone (754) 800-3261

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW7613FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Life Solutions Services Clinical CurrentSince Jan 1, 2021 Accepting new patients

Locations

710 Oakfield Dr
Ste 206
Brandon, FL 33511
Phone (754) 800-3261

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1558474098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328917770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14041 ICOT BLVD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337603702",
            "telephone_number": "727-479-1897",
            "fax_number": "727-479-1248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKER",
        "first_name": "SUSAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW7613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Z067Q",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.