Provider Demographics
NPI:1083785539
Name:GERSHENHORN, SUSAN LINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LINDA
Last Name:GERSHENHORN
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 1:7300 BLANCO RD STE 503
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4941
Mailing Address - Country:US
Mailing Address - Phone:210-733-0990
Mailing Address - Fax:210-733-9603
Practice Address - Street 1:7300 BLANCO RD STE 503
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4941
Practice Address - Country:US
Practice Address - Phone:210-733-0990
Practice Address - Fax:210-733-9603
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOU87PMedicare ID - Type Unspecified