Active NPI
Susan Lee, PH.D.
- Clinical Psychologist
- Columbia, MD
National Provider Identifier
1811014582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4067
- Practice address
- 10796 Hickory Ridge Rd
Columbia, MD 21044-3646 - Phone
- (410) 730-8877
- Fax
- (410) 997-0396
- NPI assigned
- Mar 26, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4067 | MD | Primary |
Addresses
Primary practice location
10796 Hickory Ridge Rd
Columbia, MD 21044-3646
Mailing address
9964 Fragrant Lilies Way
Laurel, MD 20723-5606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060330000156 | MD | Practitioner - Clinical Psychologist | 3971511189 | Practice locations: Columbia, MD |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2003
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10808 Hickory Ridge Rd
Columbia, MD 21044-3622
Phone (410) 258-0370
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4067 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811014582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9964 FRAGRANT LILIES WAY",
"city": "LAUREL",
"state": "MD",
"postal_code": "207235606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10796 HICKORY RIDGE RD",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210443646",
"telephone_number": "410-730-8877",
"fax_number": "410-997-0396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SUSAN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "4067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.