Provider Demographics
NPI:1114145620
Name:MIGNONE, SUZANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:MIGNONE
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 1:3860 SHERIDAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3624
Mailing Address - Country:US
Mailing Address - Phone:954-322-0348
Mailing Address - Fax:954-322-0397
Practice Address - Street 1:3860 SHERIDAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3624
Practice Address - Country:US
Practice Address - Phone:954-322-0348
Practice Address - Fax:954-322-0397
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7234103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic