Provider Demographics
NPI:1073959821
Name:CHANDERBHAN PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:CHANDERBHAN PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:CHANDERBHAN PSYCHOLOGICAL SERVICES PLLC SUSAN CHANDERBHAN-FORDE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO / LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDERBHAN-FORDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:956-898-1595
Mailing Address - Street 1:5219 MCPHERSON RD STE 312
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-7322
Mailing Address - Country:US
Mailing Address - Phone:956-898-1595
Mailing Address - Fax:
Practice Address - Street 1:5219 MCPHERSON RD STE 312
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-7322
Practice Address - Country:US
Practice Address - Phone:956-898-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty