Provider Demographics
NPI:1003358102
Name:SPINRAD, SUSAN (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SPINRAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:ESTERLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 18823
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94309-8823
Mailing Address - Country:US
Mailing Address - Phone:650-599-5825
Mailing Address - Fax:
Practice Address - Street 1:560 OXFORD AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1153
Practice Address - Country:US
Practice Address - Phone:650-599-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical