Basic Information
| Provider Information | |||||||||
| NPI: | 1497782957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANDES | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 NW 14TH ST | ||||||||
| Address2: | #212 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331362137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052437550 | ||||||||
| FaxNumber: | 3052437548 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 NW 14TH ST | ||||||||
| Address2: | #212 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331362137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052437550 | ||||||||
| FaxNumber: | 3052437548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 08/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | PY4467 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC0700X | PY4467 | FL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.