Provider Demographics
NPI:1255353728
Name:JAMES, SUZANNE MULCAHY (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MULCAHY
Last Name:JAMES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:LYNN
Other - Last Name:MULCAHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:6185 MAPLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-4407
Mailing Address - Country:US
Mailing Address - Phone:502-472-6140
Mailing Address - Fax:859-342-0999
Practice Address - Street 1:495 ERLANGER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1468
Practice Address - Country:US
Practice Address - Phone:859-342-6444
Practice Address - Fax:859-342-0999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1419103TC0700X
PAPS016198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCP00212Medicare PIN