Provider Demographics
NPI:1407905342
Name:ENTEEN, SUSAN RIVA (JD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RIVA
Last Name:ENTEEN
Suffix:
Gender:F
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-1705
Mailing Address - Country:US
Mailing Address - Phone:415-206-7605
Mailing Address - Fax:415-206-7630
Practice Address - Street 1:1309 EVANS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1705
Practice Address - Country:US
Practice Address - Phone:415-206-7605
Practice Address - Fax:415-206-7630
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health