Provider Demographics
NPI:1609068725
Name:FRANK, SUSAN (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FRANK
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 1:1308 DEVILS REACH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2806
Mailing Address - Country:US
Mailing Address - Phone:703-582-2406
Mailing Address - Fax:703-490-5505
Practice Address - Street 1:1308 DEVILS REACH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2806
Practice Address - Country:US
Practice Address - Phone:703-582-2406
Practice Address - Fax:703-490-5505
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000526174400000X
VA0810004390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No174400000XOther Service ProvidersSpecialist