Provider Demographics
NPI:1104383579
Name:REYNAUD-ROEPKE, SUZANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:REYNAUD-ROEPKE
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 1:3477 LILY WAY APT 307
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3496
Mailing Address - Country:US
Mailing Address - Phone:760-937-0626
Mailing Address - Fax:
Practice Address - Street 1:15951 LOS GATOS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3428
Practice Address - Country:US
Practice Address - Phone:408-358-1853
Practice Address - Fax:408-358-1802
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3636103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist