=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023337086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN LLOYD-MERRICK PSYD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2010
-----------------------------------------------------
Last Update Date | 06/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 CROOKED TREE TRL
-----------------------------------------------------
City | DELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32724-1371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-218-5224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 336 CROOKED TREE TRL
-----------------------------------------------------
City | DELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32724-1371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-218-5224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | SUSAN MARIE LLOYD-MERRICK
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 219-218-5224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 20042376A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------