Provider Demographics
NPI:1134340425
Name:DANIEL, SUSAN KAY (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 S RIDGE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-2877
Mailing Address - Country:US
Mailing Address - Phone:407-740-0208
Mailing Address - Fax:407-740-0242
Practice Address - Street 1:761 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6835
Practice Address - Country:US
Practice Address - Phone:407-740-0208
Practice Address - Fax:407-740-0242
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004570103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist