Provider Demographics
NPI:1306077979
Name:LERNER, SUE R (PHD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:R
Last Name:LERNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6773 E GELDING DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3494
Mailing Address - Country:US
Mailing Address - Phone:602-320-8757
Mailing Address - Fax:
Practice Address - Street 1:6773 E GELDING DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3494
Practice Address - Country:US
Practice Address - Phone:602-320-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4019103TC2200X
TX24509103TC2200X
TX30425103TS0200X
AZ3474589103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool