Provider Demographics
NPI:1124606686
Name:SIBILLA, SUZANNE ROSE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ROSE
Last Name:SIBILLA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 METAIRIE PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3826
Mailing Address - Country:US
Mailing Address - Phone:925-785-8215
Mailing Address - Fax:
Practice Address - Street 1:140 METAIRIE PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3826
Practice Address - Country:US
Practice Address - Phone:925-785-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA31830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor