Healthcare Provider Details

I. General information

NPI: 1194741306
Provider Name (Legal Business Name): SUSAN RACHEL BEREL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 PEACHTREE PKWY STE D-309
SUWANEE GA
30024-6054
US

IV. Provider business mailing address

3245 PEACHTREE PKWY STE D-309
SUWANEE GA
30024-6054
US

V. Phone/Fax

Practice location:
  • Phone: 770-501-6052
  • Fax: 770-501-9220
Mailing address:
  • Phone: 770-501-6052
  • Fax: 770-501-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2968
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: