Basic Information
| Provider Information | |||||||||
| NPI: | 1255353728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | MULCAHY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MULCAHY | ||||||||
| OtherFirstName: | SUZANNE | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PSY.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6185 MAPLERIDGE DR | ||||||||
| Address2: | |||||||||
| City: | TAYLOR MILL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410154407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024726140 | ||||||||
| FaxNumber: | 8593420999 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 ERLANGER RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410181468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593426444 | ||||||||
| FaxNumber: | 8593420999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 03/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1419 | KY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | PS016198 | PA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.