Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY16727 | CA |
N | 103TC0700X | Clinical Psychologist | PSY16727 | CA |
N | 102L00000X | Psychologist | PSY16727 | CA |
N | 103T00000X | Psychologist | PSY16727 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY16727 | CA |
N | 103G00000X | Clinical Psychologist | PSY16727 | CA |
N | 103TC0700X | Clinical Psychologist | PSY16727 | CA |
N | 103TP2701X | Group Psychotherapist | PSY16727 | CA |
NPI | 1366464208 |
---|---|
Provider Name | Dr. Susan Frances Tapert |
First Address | San Diego, CA 92161-0002 |
Second Address | San Diego, CA 92161-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251224 | MHN (01) | CA |