Provider Demographics
NPI:1093856361
Name:KAPLAN, SUSAN LINDA (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LINDA
Last Name:KAPLAN
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:PO BOX 61253
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6041
Mailing Address - Country:US
Mailing Address - Phone:949-559-0816
Mailing Address - Fax:949-743-2996
Practice Address - Street 1:780 ROOSEVELT
Practice Address - Street 2:SUITE 131
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3660
Practice Address - Country:US
Practice Address - Phone:949-559-0816
Practice Address - Fax:949-743-2996
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12066AMedicare ID - Type Unspecified