Lake Neurodiversity, LLC

Primary specialty

School PsychologistTaxonomy code 103TS0200X

Legal business name

LAKE NEURODIVERSITY, LLC

Practice address

711 W Main St Ste 127
Leesburg, FL 34748-5128

Phone

(352) 460-1925

NPI assigned

Mar 14, 2024

Last updated

Mar 14, 2024By 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 Andrews, PSY.D.NPI 1972199008

Title

Co-Owner, Psychologist

Phone

(352) 348-6989

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 1659157428
  NPD tax ID

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": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1790544658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W MAIN ST STE 127",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485128",
            "telephone_number": "352-460-1925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W MAIN ST STE 127",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485128",
            "telephone_number": "352-460-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NEURODIVERSITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CO-OWNER, PSYCHOLOGIST",
        "authorized_official_telephone_number": "352-348-6989",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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
• Lake Surgical Clinic PA

• 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 Mar 14, 2024; 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.