Healthcare Provider Details

I. General information

NPI: 1477600302
Provider Name (Legal Business Name): SUSAN BEDRIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N HIATUS RD SUITE 213
PEMBROKE PINES FL
33026-5206
US

IV. Provider business mailing address

700 N HIATUS RD SUITE 213
PEMBROKE PINES FL
33026-5206
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-0411
  • Fax: 954-431-0413
Mailing address:
  • Phone: 954-431-0411
  • Fax: 954-431-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: