Provider Demographics
NPI:1508154899
Name:VONBAEYER, SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:
Last Name:VONBAEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 PARK HILLS RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1746
Mailing Address - Country:US
Mailing Address - Phone:510-849-4403
Mailing Address - Fax:
Practice Address - Street 1:1169 PARK HILLS RD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1746
Practice Address - Country:US
Practice Address - Phone:510-849-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11893102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst