Provider Demographics
NPI:1083890768
Name:GAMBLE, SUSAN R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25020 LAS BRISAS RD # 206
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4064
Mailing Address - Country:US
Mailing Address - Phone:626-319-3258
Mailing Address - Fax:951-297-3902
Practice Address - Street 1:25020 LAS BRISAS RD # 206
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4064
Practice Address - Country:US
Practice Address - Phone:626-319-3258
Practice Address - Fax:951-297-3902
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical