Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY17045 | CA |
N | 103T00000X | Psychologist | PSY17045 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY17045 | CA |
N | 103G00000X | Clinical Psychologist | PSY17045 | CA |
N | 103TC0700X | Clinical Psychologist | PSY17045 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY17045 | CA |
NPI | 1255472809 |
---|---|
Provider Name | Dr. Suzanne Dee Zachary |
First Address | Glendale, CA 91202-1302 |
Second Address | Encino, CA 91436-1118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |