Provider Demographics
NPI:1376016501
Name:SUSAN J MENDELSOHN PA
Entity type:Organization
Organization Name:SUSAN J MENDELSOHN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-294-7036
Mailing Address - Street 1:204 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3622
Mailing Address - Country:US
Mailing Address - Phone:954-294-7036
Mailing Address - Fax:954-652-1483
Practice Address - Street 1:1919 NE 45TH ST STE 218
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5136
Practice Address - Country:US
Practice Address - Phone:954-294-7036
Practice Address - Fax:954-652-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty