Provider Demographics
NPI:1144393315
Name:FOLCIK, SUSANNAH HELEN (ASW)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:HELEN
Last Name:FOLCIK
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N 9TH ST
Mailing Address - Street 2:APARTMENT 1B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3464
Mailing Address - Country:US
Mailing Address - Phone:408-628-5567
Mailing Address - Fax:408-364-4010
Practice Address - Street 1:251 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1940
Practice Address - Country:US
Practice Address - Phone:408-550-5784
Practice Address - Fax:408-364-4010
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3417OtherUNICARE #