Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0006699 | NY |
N | 103T00000X | Psychologist | 0006699 | NY |
N | 103G00000X | Clinical Psychologist | 0006699 | NY |
N | 103TC0700X | Clinical Psychologist | 0006699 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0006699 | NY |
NPI | 1003874207 |
---|---|
Provider Name | Dr. Susan Holmes Mcdaniel |
First Address | Rochester, NY 14620-1401 |
Second Address | Rochester, NY 14620-1401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
711384 | AETNA (01) | NY |
MD431J | PREFERRED CARE (01) | NY |