Provider Demographics
NPI:1427260470
Name:HANSEN-ENGELHARD, SUSAN ELIZABETH (MA, LMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:HANSEN-ENGELHARD
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 W SAND LAKE RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5284
Mailing Address - Country:US
Mailing Address - Phone:407-625-3549
Mailing Address - Fax:407-826-1775
Practice Address - Street 1:7345 W SAND LAKE RD
Practice Address - Street 2:SUITE 221
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5284
Practice Address - Country:US
Practice Address - Phone:407-625-3549
Practice Address - Fax:407-826-1775
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6728OtherBCBS FLORIDA PROVIDER ID