Provider Demographics
NPI:1043526304
Name:CHRISTIANSEN, SUSAN J (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 HARBOUR ISLE PL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3231
Mailing Address - Country:US
Mailing Address - Phone:561-688-8787
Mailing Address - Fax:
Practice Address - Street 1:1555 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2323
Practice Address - Country:US
Practice Address - Phone:561-688-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist