Provider Demographics
NPI:1487800835
Name:SIFRAN, SUSANA ELISA (MHC)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:ELISA
Last Name:SIFRAN
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S OCEAN DRIVE
Mailing Address - Street 2:# 5-G
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019
Mailing Address - Country:US
Mailing Address - Phone:786-553-6038
Mailing Address - Fax:
Practice Address - Street 1:2040 NE 163RD ST
Practice Address - Street 2:# 305
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:786-553-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9186101YM0800X
FLMH9186101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9355082OtherAETNA