Healthcare Provider Details

I. General information

NPI: 1053658179
Provider Name (Legal Business Name): SUSAN M PSIMER SCLISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 RUTHERFORD RD
GREENVILLE SC
29609-3927
US

IV. Provider business mailing address

1132 RUTHERFORD RD
GREENVILLE SC
29609-3927
US

V. Phone/Fax

Practice location:
  • Phone: 864-250-0005
  • Fax: 864-250-0028
Mailing address:
  • Phone: 864-250-0005
  • Fax: 864-250-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number003742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: