Provider Demographics
NPI:1053486324
Name:SCATENA, SUSAN ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:SCATENA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 DUBLIN BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:925-803-1617
Mailing Address - Fax:925-828-8238
Practice Address - Street 1:11740 DUBLIN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:925-803-1617
Practice Address - Fax:925-828-8238
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL12752Medicare ID - Type Unspecified