Provider Demographics
NPI:1003874207
Name:MCDANIEL, SUSAN HOLMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HOLMES
Last Name:MCDANIEL
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 1:777 S CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1401
Mailing Address - Country:US
Mailing Address - Phone:585-279-4820
Mailing Address - Fax:585-442-8319
Practice Address - Street 1:777 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1401
Practice Address - Country:US
Practice Address - Phone:585-279-4820
Practice Address - Fax:585-442-8319
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6699103T00000X
NY0006699103T00000X, 103TC0700X, 103TC2200X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010006699OtherBLUE CHOICE
NY711384OtherAETNA
NYMD431JOtherPREFERRED CARE