Provider Demographics
NPI:1396003786
Name:PEASE, SUSAN KAY (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:PEASE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 LENARD DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3338
Mailing Address - Country:US
Mailing Address - Phone:510-331-1551
Mailing Address - Fax:
Practice Address - Street 1:20253 REDWOOD RD
Practice Address - Street 2:STE A
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4331
Practice Address - Country:US
Practice Address - Phone:510-247-9831
Practice Address - Fax:510-247-9825
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist