Organization
LAKE NEURODIVERSITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN M ANDREWS PSY.D. (CO-OWNER)
(352) 460-1925
Entity
Organization
Contact information
Practice address
117 N 7TH ST, LEESBURG, FL 34748-5115
(352) 460-1925
Mailing address
12501 LAKE RIDGE CIR, CLERMONT, FL 34711-8585
(352) 460-1925
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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