Provider Demographics
NPI:1649203514
Name:ANDREWS, SUSAN R (PH D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N I 10 SERVICE RD W STE 224
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6858
Mailing Address - Country:US
Mailing Address - Phone:504-455-0109
Mailing Address - Fax:504-889-9867
Practice Address - Street 1:3925 N I 10 SERVICE RD W STE 224
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6858
Practice Address - Country:US
Practice Address - Phone:504-455-0109
Practice Address - Fax:504-889-9867
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA270103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20750OtherBLUE CROSS PROVIDER NUMBE
LA20750OtherBLUE CROSS PROVIDER NUMBE