Provider Demographics
NPI:1437129889
Name:REICHMANN, SUSAN HELENE (MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HELENE
Last Name:REICHMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3216
Mailing Address - Country:US
Mailing Address - Phone:310-319-1579
Mailing Address - Fax:310-319-9499
Practice Address - Street 1:3331 OCEAN PARK BLVD
Practice Address - Street 2:SUITE #103
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3216
Practice Address - Country:US
Practice Address - Phone:310-319-8589
Practice Address - Fax:310-319-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33995106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist