Provider Demographics
NPI:1669531596
Name:MENDELSOHN, SUSAN J (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:MENDELSOHN
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 1:204 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8567103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical