Provider Demographics
NPI:1255324737
Name:GOLDEN, SUSAN H (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2203
Mailing Address - Country:US
Mailing Address - Phone:734-994-9133
Mailing Address - Fax:734-995-9011
Practice Address - Street 1:1510 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2437
Practice Address - Country:US
Practice Address - Phone:734-994-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301000892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H14538Medicare ID - Type Unspecified