Healthcare Provider Details

I. General information

NPI: 1003874207
Provider Name (Legal Business Name): SUSAN HOLMES MCDANIEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S CLINTON AVE
ROCHESTER NY
14620-1401
US

IV. Provider business mailing address

777 S CLINTON AVE
ROCHESTER NY
14620-1401
US

V. Phone/Fax

Practice location:
  • Phone: 585-279-4820
  • Fax: 585-442-8319
Mailing address:
  • Phone: 585-279-4820
  • Fax: 585-442-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6699
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0006699
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0006699
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0006699
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: