Provider Demographics
NPI:1336463777
Name:DAY, SUSAN BELLE (PHD, RN,)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BELLE
Last Name:DAY
Suffix:
Gender:F
Credentials:PHD, RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S FOREST RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4895
Mailing Address - Country:US
Mailing Address - Phone:209-533-1699
Mailing Address - Fax:209-533-1616
Practice Address - Street 1:103 S FOREST RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4895
Practice Address - Country:US
Practice Address - Phone:209-533-1699
Practice Address - Fax:209-532-0699
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23349103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical