Healthcare Provider Details

I. General information

NPI: 1154547164
Provider Name (Legal Business Name): SUSAN JOANNA IRELAND PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE REHABILITATION HOSPITAL CENTER
MIAMI FL
33136-1005
US

IV. Provider business mailing address

430 NE 52ND ST
MIAMI FL
33137-3031
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1267
  • Fax: 305-355-4715
Mailing address:
  • Phone: 305-546-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 5603
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5603
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 5603
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY 5603
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY 5603
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY 5603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: