Provider Demographics
NPI:1265503478
Name:VANBUSKIRK, SUSIE P (BA, BS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:P
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:BA, BS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 CROW LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3316
Mailing Address - Country:US
Mailing Address - Phone:510-541-2222
Mailing Address - Fax:
Practice Address - Street 1:15942 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2102
Practice Address - Country:US
Practice Address - Phone:510-317-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT82019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist