Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY 4982 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 4982 | FL |
N | 103G00000X | Clinical Psychologist | PY 4982 | FL |
N | 103TC0700X | Clinical Psychologist | PY 4982 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY 4982 | FL |
N | 103TR0400X | Rehabilitation Psychologist | PY 4982 | FL |
NPI | 1396962692 |
---|---|
Provider Name | Dr. Suzan Tanner Woodward |
First Address | Miami, FL 33136-1409 |
Second Address | Miami, FL 33136-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 07/04/2015 |