Lake Neurodiversity, LLC

Primary specialty

School PsychologistTaxonomy code 103TS0200X

Legal business name

LAKE NEURODIVERSITY, LLC

Practice address

117 N 7TH St
Leesburg, FL 34748-5115

Phone

(352) 460-1925

NPI assigned

Sep 6, 2023

Last updated

Sep 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Susan M Andrews, PSY.D.NPI 1972199008

Title

Co-Owner

Phone

(352) 460-1925

Specialties & licenses 1

Addresses

Tax ID family

Lake Neurodiversity LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lake Neurodiversity, LLC

  • School Psychologist
  • Leesburg, FL
  • NPI 1790544658
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Michelle Andrews, PSY.D.

  • School Psychologist
  • Altoona, FL
  • NPI 1972199008
  NPD Authorized official

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

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1659157428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12501 LAKE RIDGE CIR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118585",
            "telephone_number": "352-460-1925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N 7TH ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485115",
            "telephone_number": "352-460-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NEURODIVERSITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "352-460-1925",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Harris Health Systems LLC (Lake Harris Health Center)
• Lake Hospitalist Inc
• Lake Internal Medicine PA
• Lake Medical Billing Services Inc (Leesburg Pulmonary Diagnostics)
• Lake Medical Imaging and Breast Center at the Villages LLC
• Lake Neurodiversity, LLC
• Lake Neurology Clinic, P.a.
• Lake Pulmonary & Sleep Disorders Clinic P.a.
• Lake Square Chiropractic, P.a.
• Lake Surgery & Endoscopy Center LTD

• School Psychologist in Leesburg, FL
• Providers in Leesburg, FL by specialty
• School Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.