Provider Demographics
NPI:1962882050
Name:SUSAN L. RARICK, PH.D. LLC
Entity type:Organization
Organization Name:SUSAN L. RARICK, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RARICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-943-4000
Mailing Address - Street 1:20747 STERLINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638
Mailing Address - Country:US
Mailing Address - Phone:813-943-4000
Mailing Address - Fax:813-948-0094
Practice Address - Street 1:20747 STERLINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638
Practice Address - Country:US
Practice Address - Phone:813-943-4000
Practice Address - Fax:813-948-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty