Provider Demographics
NPI:1316026230
Name:SLATE, SUSAN HARPER
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HARPER
Last Name:SLATE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LOUISE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2656 29TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2902
Mailing Address - Country:US
Mailing Address - Phone:310-452-1992
Mailing Address - Fax:
Practice Address - Street 1:2656 29TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2902
Practice Address - Country:US
Practice Address - Phone:310-452-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 8721OtherPSYCHOLOGIST LICENSE