Provider Demographics
NPI:1487952206
Name:PAGE, SUSAN LEA (PSYD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEA
Last Name:PAGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LEA
Other - Last Name:NADEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 OAK STREET
Mailing Address - Street 2:STERLING MEDICAL ASSOCIATES ATTN: CREDENTIALS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-984-1800
Mailing Address - Fax:513-984-4909
Practice Address - Street 1:411 OAK ST
Practice Address - Street 2:STERLING MEDICAL ASSOCIATES
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2504
Practice Address - Country:US
Practice Address - Phone:513-984-1800
Practice Address - Fax:513-984-4909
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4008103TC0700X
IL071.007102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical