Susan Ann Dwyer, PHD CLINICAL PSYCHOL

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

20041233 Issued in IN

Practice address

203W Wayne St 317
Fort Wayne, IN 46802-3610

Phone

(260) 413-0040

Fax

(260) 344-2820

NPI assigned

Jul 20, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1508865650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 GLEN ELM DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468459672",
            "telephone_number": "260-413-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203W WAYNE ST 317",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468023610",
            "telephone_number": "260-413-0040",
            "fax_number": "260-344-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWYER",
        "first_name": "SUSAN",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PHD CLINICAL PSYCHOL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "IN",
            "license": "20041233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200142310",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Dutro, M.D.
• Donna S Duty, OTR
• Megan Duvall, PHARMD
• Derek Mensah Dwumfua
• Lorie L. Dwyer, NP
• Trisha Dwyer
• Heather Halsey Dye, LMHCA, LICENSED MENT
• Jon'Nea R Dye, MSN, FNP-C
• Samantha Dye
• Aaliyah Nicole Dyer, BCBA

• Health Service Psychologist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Health Service Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.