Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 4939 | CA |
NPI | 1164749032 |
---|---|
Provider Name | Susan Fisher |
First Address | Santa Cruz, CA 95060-1976 |
Second Address | Santa Cruz, CA 95060-1976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2010 |
Last Update Date | 25/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4939 | PROFESSIONAL LICENSE # (01) | CA |
FHC70042F | (05) | CA |
FHC70044F | (05) | CA |