Provider Demographics
NPI:1184959975
Name:SUE WHITE LCSW,CAP,P.A.
Entity type:Organization
Organization Name:SUE WHITE LCSW,CAP,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,CAP
Authorized Official - Phone:305-663-9080
Mailing Address - Street 1:1450 MADRUGA AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3164
Mailing Address - Country:US
Mailing Address - Phone:305-663-9080
Mailing Address - Fax:305-663-1084
Practice Address - Street 1:1450 MADRUGA AVE STE 304
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3164
Practice Address - Country:US
Practice Address - Phone:305-663-9080
Practice Address - Fax:305-663-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1265431282OtherINSURANCE