Susan Chanderbhan-Forde, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

36142 Issued in TX

Practice address

5219 McPherson Rd
Ste 312
Laredo, TX 78041-7322

Phone

(646) 734-8229

NPI assigned

Mar 17, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Gateway Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Laredo, TX
  • NPI 1891660759

  Corporate Director

  CMS ownership
• Gateway Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Laredo, TX
  • NPI 1013948447

  Corporate Director

  CMS ownership
• Gateway Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Zapata, TX
  • NPI 1629271648

  Corporate Director

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chanderbhan Psychological Services PLLC

  • Clinical Psychologist
  • Laredo, TX
  • NPI 1073959821
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1363478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588550400000",
    "number": "1982946935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 MCPHERSON RD",
            "address_2": "STE 312",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780417322",
            "telephone_number": "646-734-8229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5219 MCPHERSON RD",
            "address_2": "STE 312",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780417322",
            "telephone_number": "646-734-8229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDERBHAN-FORDE",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-17",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY8427",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "36142",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY8427",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "36142",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "FL",
            "license": "PY8427",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "TX",
            "license": "36142",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "36142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Champion Palomita Services Inc
• Champion Tele-Health Services LLC
• Champion Telehealth Services Inc
• Iliana Medina Chandarlis, DPT
• Chanderbhan Psychological Services PLLC
• Carlos Humberto Chapa Jr., DDS
• Deyanira Chapa I, SLPA
• Judith Chapa
• Norma Chapa
• Sonia Aidee Chapa

• Clinical Psychologist in Laredo, TX
• Providers in Laredo, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.

Verify at the official NPI Registry.