Healthcare Provider Details

I. General information

NPI: 1790036267
Provider Name (Legal Business Name): SUZANNE ELIZABETH ENGEL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PARDEE RD
ROCHESTER NY
14609-2810
US

IV. Provider business mailing address

600 PARDEE RD
ROCHESTER NY
14609-2810
US

V. Phone/Fax

Practice location:
  • Phone: 585-339-1378
  • Fax:
Mailing address:
  • Phone: 585-339-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number018997
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: