Provider Demographics
NPI:1679719728
Name:CRUM, SUSAN L (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:CRUM
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:3205 PHYSICIANS WAY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5447
Mailing Address - Country:US
Mailing Address - Phone:863-402-2222
Mailing Address - Fax:855-429-8888
Practice Address - Street 1:3205 PHYSICIANS WAY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5447
Practice Address - Country:US
Practice Address - Phone:863-402-2222
Practice Address - Fax:855-429-8888
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2020-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPY6618103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6618OtherFLORIDA BOARD OF PSYCHOLOGY