Provider Demographics
NPI:1972199008
Name:ANDREWS, SUSAN MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MICHELLE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45453 STATE ROAD 19
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:FL
Mailing Address - Zip Code:32702-9220
Mailing Address - Country:US
Mailing Address - Phone:352-348-6989
Mailing Address - Fax:
Practice Address - Street 1:45453 STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:FL
Practice Address - Zip Code:32702-9220
Practice Address - Country:US
Practice Address - Phone:352-348-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1453103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool