Provider Demographics
NPI:1417127309
Name:MILLSTEIN, SUSAN G (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:G
Last Name:MILLSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:M
Other - Last Name:PRENTKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 FIFER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1134
Mailing Address - Country:US
Mailing Address - Phone:415-820-1611
Mailing Address - Fax:
Practice Address - Street 1:2 FIFER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1134
Practice Address - Country:US
Practice Address - Phone:415-820-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical