Provider Demographics
NPI:1316917743
Name:DANAHY, SUSAN ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANNE
Last Name:DANAHY
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 1:4400 BAYOU BLVD
Mailing Address - Street 2:BUILDING 51
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-478-2557
Mailing Address - Fax:850-484-2875
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:BUILDING 51
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-478-2557
Practice Address - Fax:850-484-2875
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593117099OtherTIN
FL593117099OtherTIN
FL75806Medicare ID - Type UnspecifiedPROVIDER ID