Provider Demographics
NPI:1467922575
Name:SUSAN BLANDINO PSYD PLLC
Entity Type:Organization
Organization Name:SUSAN BLANDINO PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANDINO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:972-727-3627
Mailing Address - Street 1:101 W MCDERMOTT DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2751
Mailing Address - Country:US
Mailing Address - Phone:972-727-3627
Mailing Address - Fax:972-521-6515
Practice Address - Street 1:101 W MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2751
Practice Address - Country:US
Practice Address - Phone:972-727-3627
Practice Address - Fax:972-521-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty