Provider Demographics
NPI:1164462883
Name:O'BRIEN, SUZANNE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2125 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6260
Mailing Address - Country:US
Mailing Address - Phone:760-877-0175
Mailing Address - Fax:760-967-6042
Practice Address - Street 1:2125 S EL CAMINO REAL
Practice Address - Street 2:SUITE 104
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6260
Practice Address - Country:US
Practice Address - Phone:760-877-0175
Practice Address - Fax:760-967-6042
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20502103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20502Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST