Provider Demographics
NPI:1073901237
Name:DR. SUSAN ANN VARADY, PH.D., PC
Entity Type:Organization
Organization Name:DR. SUSAN ANN VARADY, PH.D., PC
Other - Org Name:ALTOS PERFORMANCE PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VARADY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-393-2027
Mailing Address - Street 1:13405 CEDARVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7641
Mailing Address - Country:US
Mailing Address - Phone:719-393-2027
Mailing Address - Fax:
Practice Address - Street 1:13405 CEDARVILLE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-7641
Practice Address - Country:US
Practice Address - Phone:719-393-2027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427217991OtherNPI
CO261081OtherMEDICARE PTAN