Active NPI
Susan Jane Simonian, PH.D., ABPP
- Clinical Psychologist
- Mount Pleasant, SC
National Provider Identifier
1457546855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 624
- Practice address
- 857 Coleman Blvd Ste C
Mount Pleasant, SC 29464-4043 - Phone
- (843) 856-0006
- Fax
- (843) 971-0406
- NPI assigned
- Sep 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 624 | SC | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X |
Addresses
Primary practice location
857 Coleman Blvd Ste C
Mount Pleasant, SC 29464-4043
Mailing address
857 Coleman Blvd Ste C
Mount Pleasant, SC 29464-4043
Phone (843) 856-0006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 624 | SC | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189296000000",
"number": "1457546855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "857 COLEMAN BLVD STE C",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294644043",
"telephone_number": "843-856-0006",
"fax_number": "843-971-0406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "857 COLEMAN BLVD STE C",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294644043",
"telephone_number": "843-856-0006",
"fax_number": "843-971-0406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONIAN",
"first_name": "SUSAN",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "PH.D., ABPP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-09",
"last_updated": "2007-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SC",
"license": "624",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.