Provider Demographics
NPI:1114229218
Name:KUYPER, SUSAN CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:KUYPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:KUYPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3905 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1014
Mailing Address - Country:US
Mailing Address - Phone:415-580-2456
Mailing Address - Fax:415-657-1774
Practice Address - Street 1:1525 SILVER AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-1229
Practice Address - Country:US
Practice Address - Phone:415-337-2403
Practice Address - Fax:415-330-5740
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical