Provider Demographics
NPI:1487604351
Name:PERSONS, SUZANNE PFUND (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:PFUND
Last Name:PERSONS
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 1:575 2ND AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4166
Mailing Address - Country:US
Mailing Address - Phone:727-898-9080
Mailing Address - Fax:
Practice Address - Street 1:575 2ND AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4166
Practice Address - Country:US
Practice Address - Phone:727-898-9080
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health