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General NPI Number Information
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NPI Number | 1376016501
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Entity Type | Organization
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Legal Business Name | SUSAN J MENDELSOHN PA
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 1919 NE 45TH ST STE 218
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-5136
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Country | US
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Telephone | 954-294-7036
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Fax | 954-652-1483
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Provider Business Mailing Address
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Address Line | 204 WASHINGTON AVENUE
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-3622
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Country | US
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Telephone | 954-294-7036
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Fax | 954-652-1483
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN J MENDELSOHN
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Credential | PSYD
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Telephone | 954-294-7036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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