Provider Demographics
NPI:1295743680
Name:KORTLANDER, SUSAN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:KORTLANDER
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2771 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3642
Mailing Address - Country:US
Mailing Address - Phone:954-385-4696
Mailing Address - Fax:954-385-8385
Practice Address - Street 1:2771 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3642
Practice Address - Country:US
Practice Address - Phone:954-385-4696
Practice Address - Fax:954-385-8385
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY5774103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist