Provider Demographics
NPI:1588771059
Name:SEDGE, SUZANNE KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:KAY
Last Name:SEDGE
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 1:11775 LONE TREE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4315
Mailing Address - Country:US
Mailing Address - Phone:410-730-6652
Mailing Address - Fax:410-730-7978
Practice Address - Street 1:11775 LONE TREE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4315
Practice Address - Country:US
Practice Address - Phone:410-730-6652
Practice Address - Fax:410-730-7978
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02239103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling