SUSAN PRESCOTT PETRIE (NPI# 1457315350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457315350 |
| Entity Type | Individual |
| Full Name | SUSAN PRESCOTT PETRIE |
| Credential | LMHC |
| Practice Address |
515 W Main St Leesburg FL 34748-5148 |
| Mailing Address |
Po Box 521 Belleview FL 34421-0521 |
| Practice Telephone | 3523157500 |
| Practice Fax Number | 3523606582 |
| Mailing Telephone | 3523157500 |
| Mailing Fax Number | 3523606582 |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
MH 5776 | FL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS BLUE SHIELD # | Z062X | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306348438 | Susan Petrie | Technician | 3500 Lakeside Ct Ste 145, Reno, NV 89509-4866 | 2018-03-05 |
| Street Address |
515 W MAIN ST |
| City | LEESBURG |
| State | FL |
| Zip Code | 34748-5148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568517522 | Michael Vincent Dwyer | Counselor | 515 W Main St, Leesburg, FL 34748-5148 | 2007-01-23 |
| 1285695254 | Jill Baird | Social Worker | 515 W Main St, Leesburg, FL 34748-5148 | 2006-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437610243 | Ashley Shamsa Martin | Behavior Technician | 292 Bent Oak Ct, Leesburg, FL 34748 | 2019-03-26 |
| 1891278875 | Luis O Aponte Mendoza | Physician Assistant | 704 Doctors Ct., Suite 101, Leesburg, FL 34748 | 2018-09-14 |
| 1881197903 | Physician Associates LLC | Internal Medicine | 22316 Us Highway 27, Leesburg, FL 34748 | 2018-03-15 |
| 1184136145 | Infinite Support Services LLC | In Home Supportive Care | 129 Grove Ridge Circle, 104, Leesburg, FL 34748 | 2017-10-31 |
| 1619403037 | Massage and Wellness Care | Health Maintenance Organization | 1218 W. Dixie Ave, Suite A, Leesburg, FL 34748 | 2017-05-04 |
| 1497202675 | Prime Radiology of Leesburg Inc | Radiology | 600 N W Blvd, Suite E, Leesburg, FL 34748 | 2016-09-06 |
| 1023480332 | Juanita Elizabeth Simpson | Contractor | 1911 Harcourt Drive, Leesburg, FL 34748 | 2015-10-26 |
| 1467835900 | Serenity Choice Place, LLC | Community/Behavioral Health | 721 Balmoral Circle, Leesburg, FL 34748 | 2015-07-01 |
| 1356738397 | Touching Heart's Group Homes, LLC | Community/Behavioral Health | 31809 Sunpark Cir, Leesburg, FL 34748 | 2015-04-16 |
| 1386035269 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 1103 N 14th Street, Leesburg, FL 34748 | 2015-02-12 |
| Find all providers in zip 34748 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730143249 | Virginia Samantha Lindmeier | Psychologist | 100 S 11th St, Suite 101, Leesburg, FL 34748-5765 | 2006-04-12 |
| 1548687841 | Aisha Thompson | Psychologist | 42009 Victory Ln, Leesburg, VA 20176-6269 | 2014-03-25 |
| 1003138744 | Avy Stock | Psychologist | 42009 Victory Ln, Leesburg, VA 20176-6269 | 2010-02-23 |
| 1003146473 | Holiday Rondeau | Psychologist | 215 Loudoun St Se, Leesburg, VA 20175-3115 | 2010-01-07 |
| 1356416929 | Erin Mcnett | Psychologist | 102 Heritage Way Ne, Suite 302, Leesburg, VA 20176-4544 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376142463 | Krecer Psychological Services, LLC | Psychologist | 2015 Meadow Pond Way, Orlando, FL 32824-5060 | 2020-10-20 |
| 1912525866 | Vicky Wolfe | Psychologist | 203 Hollywood Blvd Ne, Fort Walton Beach, FL 32548-5775 | 2020-07-08 |
| 1144841727 | Chalfin Psychology Services, Inc. | Psychologist | 7800 Sw 57th Ave Ste 114, South Miami, FL 33143-5543 | 2020-05-05 |
| 1346738705 | Tampa Psychology Group | Psychologist | 1463 Oakfield Dr Ste 109, Brandon, FL 33511 | 2018-05-01 |
| 1447765631 | Cristina Anderson | Psychologist | 3081 Salzedo St Ste 202, Coral Gables, FL 33134-6725 | 2017-12-10 |
| 1073028734 | Audra Walsh, Phd, LLC | Psychologist | 1039 Park St N, St Petersburg, FL 33710-4317 | 2017-12-04 |
| 1801327564 | Paola Granados-radlick | Psychologist | 1200 Brickell Ave Ste 850, Miami, FL 33131-3212 | 2017-03-24 |
| 1205388527 | Safe Landing, Inc | Psychologist | 9200 Nw 8th Ave, Miami, FL 33150-2016 | 2016-11-03 |
| 1124574595 | Michelle C Fernandez | Psychologist | 7800 Sw 57th Avenue Suite 114, South Miami, FL 33143 | 2016-08-26 |
| 1952764060 | Penelope L. Norton, Phd | Psychologist | 555 W Granada Blvd Ste E3, Ormond Beach, FL 32174-9401 | 2016-04-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.