Provider Demographics
NPI:1477948750
Name:DESMOND, SUZI ELIZABETH (MS)
Entity Type:Individual
Prefix:MS
First Name:SUZI
Middle Name:ELIZABETH
Last Name:DESMOND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:SUZI
Other - Middle Name:ELIZABETH
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:100 MASONIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118
Mailing Address - Country:US
Mailing Address - Phone:415-567-8370
Mailing Address - Fax:415-292-5531
Practice Address - Street 1:100 MASONIC AVENUE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-567-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF85786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist