Organization
LAKE NEURODIVERSITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN ANDREWS PSY.D. (CO-OWNER, PSYCHOLOGIST)
(352) 348-6989
Entity
Organization
Contact information
Practice address
711 W MAIN ST STE 127, LEESBURG, FL 34748-5128
(352) 460-1925
Mailing address
711 W MAIN ST STE 127, LEESBURG, FL 34748-5128
(352) 460-1925
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
03/14/2024
Last updated
03/14/2024
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