Provider Demographics
NPI:1215606553
Name:BUKINIK, SUZANNE (MFT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BUKINIK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 WILSHIRE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2400
Mailing Address - Country:US
Mailing Address - Phone:310-271-0300
Mailing Address - Fax:
Practice Address - Street 1:8383 WILSHIRE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2400
Practice Address - Country:US
Practice Address - Phone:424-281-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist