Provider Demographics
NPI:1437286069
Name:KOLODNY, SUSAN L (DMH)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:KOLODNY
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 COLLEGE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2642
Mailing Address - Country:US
Mailing Address - Phone:510-339-2877
Mailing Address - Fax:510-339-2877
Practice Address - Street 1:6239 COLLEGE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2642
Practice Address - Country:US
Practice Address - Phone:510-339-2877
Practice Address - Fax:510-339-2877
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8555103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist