Provider Demographics
NPI:1487839163
Name:HERRICK, SUSAN (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HERRICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W MIDDLEFIELD RD
Mailing Address - Street 2:#998
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3211
Mailing Address - Country:US
Mailing Address - Phone:650-906-2258
Mailing Address - Fax:650-473-1455
Practice Address - Street 1:357 CASTRO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1256
Practice Address - Country:US
Practice Address - Phone:650-906-2258
Practice Address - Fax:650-473-1455
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist