Provider Demographics
NPI:1114008612
Name:SUSMAN, VALERIE GOLDFINE
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:GOLDFINE
Last Name:SUSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 WILSHIRE BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1426
Mailing Address - Country:US
Mailing Address - Phone:310-204-8639
Mailing Address - Fax:
Practice Address - Street 1:530 WILSHIRE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1426
Practice Address - Country:US
Practice Address - Phone:310-204-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA085946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15902Medicare ID - Type Unspecified
CAQ24808Medicare UPIN