Provider Demographics
NPI:1164638664
Name:RHODES, SUSAN KAY (RN, MS, MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:RHODES
Suffix:
Gender:F
Credentials:RN, MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5588 SONOMA DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7747
Mailing Address - Country:US
Mailing Address - Phone:510-914-7317
Mailing Address - Fax:510-792-0802
Practice Address - Street 1:39140 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1612
Practice Address - Country:US
Practice Address - Phone:510-914-7317
Practice Address - Fax:510-792-0802
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist