Provider Demographics
NPI:1669849014
Name:MIRE, SUSAN
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W WILLIAM DAVID PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1644
Mailing Address - Country:US
Mailing Address - Phone:504-606-5433
Mailing Address - Fax:
Practice Address - Street 1:2346 BELMAR DR
Practice Address - Street 2:APT 1
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-2053
Practice Address - Country:US
Practice Address - Phone:504-606-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health