Provider Demographics
NPI:1629097415
Name:ALEXANDER, SUSAN BRADY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BRADY
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:BUCHANAN
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1145 EXECUTIVE CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4586
Mailing Address - Country:US
Mailing Address - Phone:919-460-1414
Mailing Address - Fax:
Practice Address - Street 1:1145 EXECUTIVE CIR
Practice Address - Street 2:SUITE C
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4586
Practice Address - Country:US
Practice Address - Phone:919-460-1414
Practice Address - Fax:919-460-0238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist