Provider Demographics
NPI:1669652657
Name:GIEROK, SUSAN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:GIEROK
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 1:1800 S AUSTRALIAN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6450
Mailing Address - Country:US
Mailing Address - Phone:561-317-9955
Mailing Address - Fax:561-689-0806
Practice Address - Street 1:1800 S AUSTRALIAN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6450
Practice Address - Country:US
Practice Address - Phone:561-317-9955
Practice Address - Fax:561-689-0806
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1334103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051527334OtherBLUE CROSS PROVIDER NUMBE
AL051555700OtherMEDICARE PROVIDER NUMBER
AL051555700OtherMEDICARE PROVIDER NUMBER