Provider Demographics
NPI:1508904194
Name:TRUTT, SUSAN D (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:TRUTT
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 1:7301 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 208-A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3458
Mailing Address - Country:US
Mailing Address - Phone:561-392-4700
Mailing Address - Fax:561-394-9559
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 208-A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3458
Practice Address - Country:US
Practice Address - Phone:561-392-4700
Practice Address - Fax:561-394-9559
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004271103T00000X
OH3605103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73611Medicare ID - Type Unspecified