Provider Demographics
NPI:1063688240
Name:O'BRIEN, SUSAN F (PH D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:F
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:F
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:2121 MARKHAM WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3139
Mailing Address - Country:US
Mailing Address - Phone:916-799-5736
Mailing Address - Fax:
Practice Address - Street 1:2830 I ST STE 203
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4311
Practice Address - Country:US
Practice Address - Phone:961-799-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical