Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY 5603 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 5603 | FL |
N | 102L00000X | Psychologist | PY5603 | FL |
N | 103T00000X | Psychologist | PY5603 | FL |
N | 103G00000X | Clinical Psychologist | PY 5603 | FL |
N | 103TC0700X | Clinical Psychologist | PY 5603 | FL |
N | 103TH0100X | Health Service | PY 5603 | FL |
N | 103TP2701X | Group Psychotherapist | PY 5603 | FL |
N | 103TR0400X | Rehabilitation Psychologist | PY 5603 | FL |
NPI | 1154547164 |
---|---|
Provider Name | Dr. Susan Joanna Ireland |
First Address | Miami, FL 33137-3031 |
Second Address | Miami, FL 33136-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 02/06/2021 |